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At the Eleventh Hour: Psychosocial Dynamics in Short Hospice Stays

Correspondence: Address correspondence to Deborah P. Waldrop, MSW, PhD, Assistant Professor, University at Buffalo School of Social Work, 633 Baldy Hall, Box 601050, Buffalo, NY 14260. E-mail: dwaldrop{at}buffalo.edu

Purpose: This study explored the psychosocial dynamics of short hospice stays (less than 2 weeks) of cancer patients age 65 and older. Design and Methods: In-depth interviews with 59 caregivers of 50 patients were audiotaped, transcribed, and coded by using Atlas ti software. Results: A descriptive typology is presented. A late diagnosis (n = 22 or 44%) was one in which cancer was diagnosed between 2 and 4 weeks before death, rendering earlier hospice admission impossible. Late diagnoses were made because the cancer was missed, masked by comorbidities, or the person resisted seeing a health care provider. A known diagnosis (n = 25 or 50%) was one in which the diagnosis was made long before hospice admission; admission was delayed because the person elected ongoing curative treatment until the final days of life, or the family managed the care without hospice until a turning point (medical, functional, pragmatic, or emotional) occurred, making the care unmanageable. Implications: Hospice utilization is influenced by the interrelationship among patient–family–provider factors. Understanding the characteristics and needs of subgroups of terminally ill people is key to providing good care at life's end.

Key Words: End-of-life care • Cancer • Qualitative research • Hospice • Terminal illness

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