Journal article
Thematic analysis of hospice mentions in the health records of veterans with advanced kidney disease
Journal of the American Society of Nephrology
2020
Abstract
Significance Statement
Little is known regarding how decisions about hospice referral among patients with advanced kidney disease unfold in real-world clinical settings. The authors identified three dominant themes in their qualitative analysis of documentation pertaining to hospice in the electronic medical records of members of a national sample of veterans with advanced kidney disease. First, hospice and usual care seemed to function as conflicting rather than complementary models of care. Second, patients were usually referred to hospice late in the course of illness after all other options had been exhausted. Third, patients’ complex care needs sometimes complicated transitions to hospice, stretched the limits of home hospice, and fostered reliance on the acute medical system. These findings highlight the need to improve hospice transitions for patients with advanced kidney disease.
Background
Patients with advanced kidney disease are less likely than many patients with other types of serious illness to enroll in hospice. Little is known about real-world clinical decision-making related to hospice for members of this population.
Methods
We used a text search tool to conduct a thematic analysis of documentation pertaining to hospice in the electronic medical record system of the Department of Veterans Affairs, for a national sample of 1000 patients with advanced kidney disease between 2004 and 2014 who were followed until October 8, 2019.
Results
Three dominant themes emerged from our qualitative analysis of the electronic medical records of 340 cohort members with notes containing hospice mentions: (1) hospice and usual care as antithetical care models: clinicians appeared to perceive a sharp demarcation between services that could be provided under hospice versus usual care and were often uncertain about hospice eligibility criteria. This could shape decision-making about hospice and dialysis and made it hard to individualize care; (2) hospice as a last resort: patients often were referred to hospice late in the course of illness and did not so much choose hospice as accept these services after all treatment options had been exhausted; and (3) care complexity: patients’ complex care needs at the time of hospice referral could complicate transitions to hospice, stretch the limits of home hospice, and promote continued reliance on the acute care system.
Conclusions
Our findings underscore the need to improve transitions to hospice for patients with advanced kidney disease as they approach the end of life.
Metrics
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Details
- Title
- Thematic analysis of hospice mentions in the health records of veterans with advanced kidney disease
- Creators
- Ann M O'Hare - University of Puget SoundCatherine R Butler - University of WashingtonJanelle S Taylor - University of TorontoSusan P Y Wong - University of Puget SoundElizabeth K Vig - University of WashingtonRyan S Laundry - Health Services Research & DevelopmentMelissa Wachterman - VA Boston Healthcare SystemPaul L. Hebert - Health Services Research & DevelopmentChuan-Fen Liu - University of WashingtonNilka Rios-Burrows - Centers for Disease Control and Prevention
- Publication Details
- Journal of the American Society of Nephrology
- Academic Unit
- College of Nursing
- Identifiers
- 99901177840801842
- Resource Type
- Journal article