Daniel J. Van Dussen

Knowledge About Hospice Exploring Misconceptions, Attitudes, and Preferences for Care

Context: Poor knowledge and misperceptions about hospice are believed to be common, but there is scant evidence about the public’s understanding of hospice. Objectives: To examine hospice knowledge among geographically diverse adults; and describe linkages between knowledge, attitudes and beliefs about hospice care, and demographics. Methods: A small cross-sectional telephone survey of adults living in the contiguous US was conducted using randomly selected numbers (cell phone and landline) and over-sampling of minorities. Measures assessed knowledge (23-item test), attitudes (8-item scale), experiences and preferences related to hospice. Results: 123 participants completed surveys (response rate 46%). 106 (86%) had heard about hospice, 65 (54%) of whom had a personal experience with hospice. Participants had an average hospice knowledge test score of 18 (SD = 3.4) indicating moderate knowledge of hospice. A majority of respondents (62%) did not know that hospice cannot provide concurrent cure-oriented care. Misperceptions about eligibility, coverage of hospice, the provision of hospice in nursing homes or to persons who live alone were not uncommon (missed by >20%). Greater knowledge of hospice was associated with more favorable attitudes about the hospice philosophy of care (r = .22, p = .023) and a greater preference for hospice (p = .049). Respondents who were more educated, worked in the medical field, were non-Hispanic White, and had direct experience with hospice were also more likely to be more knowledgeable about hospice. Conclusion: Despite relatively high hospice awareness and favorability, myths and misperceptions about hospice still abound – and may drive ethnic disparities in end-of-life care. Educational interventions and future study are needed.

Knowledge About Hospice Care and Beliefs About Pain Management: Exploring Differences Between Hispanics and Non-Hispanics

Context: Among Hispanics, incomplete knowledge about hospice care may explain low rates of utilization and culturally-specific beliefs about pain and pain treatments may contribute to disparities in pain management. Objectives: To compare (1) knowledge and attitudes regarding hospice, (2) and beliefs about pain and pain medication between Hispanics and non-Hispanics. Methods: A cross-sectional phone-based survey of adults living in the contiguous United States was conducted using randomly selected phone numbers with over-sampling for diversity. Measures assessed knowledge (a 23-item test), attitudes (an 8-item scale), experiences, preferences related to hospice and beliefs regarding pain and pain management. Results: 123 individuals participated in the survey, 13% of whom were Hispanic. Hispanics were less likely to have heard of hospice are (p <. 001) and, among those who had, more likely to have inaccurate information about it (p = .05). Specifically, Hispanics were more likely to report that only individuals over age 65 are eligible for hospice services, which is incorrect (44% vs. 93% of non-Hispanics; p=.001). Only 67% of Hispanics knew that hospice helps family members as well as the dying person. More Hispanics (43%) than non-Hispanics (9.3%) reported that admitting pain is a sign of weakness (p < .001). A greater proportion of Hispanic respondents agreed that a good patient does not talk about pain (p = .07): 38% vs. 18% from non-Hispanics. Conclusion: Despite the increasing knowledge of hospice care among Hispanics, specific information about the scope of services remains limited. Cultural beliefs about pain management, along with inadequate knowledge of the role of pain management at end of life, persist.

Perceptions About Hospice From a Community-Based Pilot Study Lessons and Findings

Research investigating the knowledge and attitudes of diverse older adults about hospice care and end-of-life issues is needed to expand service utilization. This pilot study explored an urban area’s perceptions and awareness of hospice through local churches. The sample consisted of 148 adults age 43 and older. Although recruitment efforts resulted in a relatively homogenous sample, findings suggest a lack of knowledge about whether hospice is covered by Medicare, Medicaid, or private insurance. Perceptions of the expense of hospice, however, were not associated with knowledge of coverage. Respondents generally agreed that hospice is important and would recommend its services for their family members.

Quality of death among hospice decedents: Proxy observations from a survey of community-dwelling adults in the contiguous United States

ABSTRACT This study examines hospice service experience and quality of death. A survey of 123 community-dwelling adults in the United States found that physical comfort, pain-free, and spiritual peace were more important to respondents reporting a personal experience with hospice. A “good death” was associated with older patients who died at home, and respondent satisfaction with hospice service. A “good death” was mapped as 29 nodes and 79 links using semantic network analysis. Three subjects (patient, family, hospice), three timeframes (end-of-life, moment of dying, death), and four central causes (home, peaceful, pain-free, and expected) were identified.

What Educational Opportunities Should Professionals in Aging Provide?: A Pilot Community Assessment

With the aging workforce and the increase of older adults, educational needs of the workforce in aging services are broadening. The pilot study used a survey to examine the types of educational opportunities and needs of professionals providing services to older adults in eastern Ohio and western Pennsylvania. Respondents (25.9%) reported learning about aging through a bachelors degree program, 29.6% learned through self-study, and 33.3% reported learning on the job. Professionals are interested in enrolling in gerontology programs. Policy makers should provide funding to help educate professionals. Professional organizations should expand to ensure that employees have gerontological education.

Gender and Informal Caregiving in CCRCs: Primary Caregivers or Support Networks?

Relatively little research has been conducted on caregiving or kin support patterns among residents of newer forms of senior housing. The current research investigates variation in reported current or potential supporters by gender, age, and marital status among 687 residents of four continuing care retirement communities. Women and men tended to identify different configurations of social support, with the gender difference partially attributable to marital status (i.e., higher rates of widowhood among women). Age 75–84 was nonlinearly associated with more reported supporters, suggesting a shift in types of supporters by age. Unmarried persons more often identified friends and “others” in terms of support, in lieu of spousal support.

Accreditation of Gerontology Programs: A Look from Inside.

For over three decades, there has been considerable discussion about the development of gerontology education in the United States. A debate about accreditation is a logical outgrowth in this evolution. The dialogue about accreditation raises some important questions and gives gerontology an opportunity to further define itself. Accreditation poses opportunities and challenges that must be addressed to have a valid and meaningful discussion about the future of gerontological education. This article examines the advantages and disadvantages of accreditation for gerontology using the lens of faculty members from these three different academic programs. The authors ask: Is accreditation a good idea for each program? What are the advantages and disadvantages? Is this the right time?

Measuring Attitudes About End-of-Life Care: Evaluation of a Modified Version of the Hospice Philosophy Scale:

The Hospice Philosophy Scale (HPS) is the only scaled instrument that measures health professionals’ attitudes about end-of-life care consistent with the hospice philosophy. This study tested the properties of a modified version of the HPS to provide preliminary validation data on internal consistency, convergent validity, and factorability in a broad population of adults. A cross-sectional telephone survey designed to assess the general population’s attitudes regarding hospice use was administered. exploratory factor analysis elicited an eight-item instrument (HPS-8). The HPS-8 produced a Cronbach’s alpha of .73 and demonstrated sufficient convergent validity, including positive associations with a scale measuring the importance of relevant end-of-life issues (r = .41, p < .001), a personal preference for hospice (ρ = .36, p < .001), and, among those who had experienced hospice care, satisfaction with hospice care (ρ = .28, p < .01). Our evidence suggests the HPS-8 is a reliable and valid instrument for use with a general adult population.

Differences Among Preferred Methods for Furthering Aging Education in Ohio

Workers serving Ohios aging population will require increased levels of gerontological education. Using data from 55 Ohio counties, this project investigated the educational needs and reasons for seeking education from professionals in aging. Respondents reported interest in attaining aging related education. Preferred delivery methods included web based and interactive satellite instruction. Continuing education credit was preferred over college credit even though a high percentage indicated a desire for an additional degree (69.8%). Despite over 30 years of Ohios universities providing aging related education, 58.6% of respondents have no formal aging related training, and 11.7% have only a single course in aging. Gerontological topics that most interested participants in an area for further understanding were Alzheimers/dementia, medication, and mental health issues.