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Show Barriers to Hospice Referrals for Older Adults in the Primary Care Setting Andrew Cardon, BSN, DNP Student, Family Nurse Practitioner Program KEY FINDING(S) Lack of knowledge among primary care providers (PCPs) is a barrier to appropriate and timely referrals to Hospice. Knowledge areas identified as most deficient by this project included illnesses that qualify for hospice; family participation requirements; hospice treatment locations; length of service potential; referral initiation process; PCP participation post hospice initiation, and overall benefit of hospice. Delivering an educational module addressing these topics improved PCP knowledge of hospice, and may improve future referral practices. METHODS PURPOSE/OBJECTIVES The purpose of this project was to determine barriers to hospice referral in the primary care setting (e.g. knowledge gaps, lack of resources, poor patient education, etc.), and to attempt to address barriers by delivering an education module. The objectives were to: • Pre-education questionnaire addressing current rates of hospice referrals, thoughts about hospice, knowledge of hospice and perceived barriers to hospice referrals administered to both PCPs and hospice providers • Distributed to MD, DO, NP, and PAs in Family Practice or Hospice • Education module was developed and administered to PCPs who had completed pre-educational module questionnaire • Results of pre-education and post- education questionnaires were compared using a simple paired t-Test. • 1. Assess both hospice provider and PCP perceptions of what barriers exist for PCPs when referring older adults to hospice, particularly PCP knowledge deficits surrounding hospice referral; • 2. Develop a learning module regarding hospice and its services that addresses the barriers identified by both hospice providers and primary care providers; and • 3. Improve primary care providers’ knowledge of hospice and its services. RESULTS BACKGROUND • Primary care providers (PCP) often have best understanding of a patients overall health and wellness • PCPs are reluctant to refer older adults (>65 years old) for hospice services, even though these services have shown to improve end-of-life care • Hospice only utilized by 25% of individuals that die each year with 50% of admissions lasting 22 days or less and up to 10% lasting 24 hours or less • The number of individuals who qualify are not being referred in a timely manner decreasing the benefit they could receive from hospice • Underutilization means a lower level of care and comfort is received during end-of-life Acknowledgments Chair Advisor: Andrea Wallace, PhD, RN PCNP Program Director: Julie Balk, DNP, APRN, FNP-BC, CNE Executive Director: Pamela Hardin, PhD, RN, CNE Content Expert: Paige Kimball, MS, APRN, FNP-BC Pre-Education • 10 PCPs, 9 hospice providers completed the pre-education questionnaire • Mean hospice knowledge score for PCPs was 77.0% (SD 14.7) • Topics identified included: illness that qualify for hospice, family participation requirements, hospice treatment locations, length of service potential, referral initiation process, PCP participation post hospice initiation, and overall benefit of hospice • Barriers identified were similar between PCP and Hospice Provider groups Post-Education • 7 of the 10 PCPs completed the post-education questionnaire • Average hospice knowledge score improved to 97.5% (p=0.003) CONCLUSION • Lack of knowledge, particularly of referral process, remains leading cause of PCP referral hesitance. • Supplemental education materials, such as the provided education module proves beneficial |
