Assessment of Hospice Patients’ Goals of Care at the End of Life

Abstract

Objective: To evaluate satisfaction with inpatient hospice goals at the end of life and to determine steps for program improvement. Study design and setting: Prospective observational study of patients admitted to an inpatient Veterans Affairs Medical Center hospice unit, located in an urban setting with dedicated 16 hospice and 20 palliative care beds. Patients and their families are cared for by an interdisciplinary team. Population: Veteran population receiving care in an inpatient hospice unit whose goals are comfort care. Intervention: Two anonymous surveys of patient goals were distributed upon admission to hospice unit patients and families, who were asked to complete the first survey within 1 to 5 days of admission and the second survey 2 weeks after admission or later. Outcome measure: Patient and family centered end-of-life care outcomes, including meeting goals of care with desired symptom management, emotional support to the dying patient, coordinated care, shared decision making, and attending to the emotional needs of families. Results: Fifty patients were given surveys between June and September 2009. Response rate was 52% for the first survey and 36% for the second survey. Most important goals for 90% of veterans were control of symptoms and being with family. More than 90% of our patients’ families, responding to our second survey, strongly agreed that these goals were achieved. We also identified other needs of hospice veterans, and family surveys showed that these were also accomplished. Conclusion: Clarification and focus on goals of care improves satisfaction with end-of-life care.