Page 278 - Encyclopedia of Nursing Research

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genetics poses new opportunities in the pro- illness. “Special” patients were found to
vision of hospice care. be related to support of personhood of all
The bottom-line question for patients patients, although the “special patients” were H
and families is whether hospice has a posi- perceived to receive no preferential treat-
tive impact on QOl. Using the Hospice care ment. In fact, “special” patients were found
performance Inventory, yeung, French, and to have a positive impact on the caregivers.
leung (1999) identified six issues in which As noted, much hospice research has
patient expectations and effectiveness of care examined the impact of hospice on costs, an
were not congruent. Maximization of self- early concern of government officials when the
care and mobility were the two issues with development of a hospice benefit was being
the greatest discrepancy. patients preferred to considered. The coming of age of hospice is
do their own self-care rather than have it done indicated by the focus on enhancing hospice
to them. Another patient priority included access and focusing on the quality of remain-
dispelling fear of death which, given that this ing life of hospice patients and their informal
was investigated with a chinese population caregivers as well as the quality of the care
where it is considered a forbidden topic of con- received. research is crucial to assuring that
versation, is a challenge. Other patient priori- hospice care is all that it purports to be.
ties identified included gaining enough sleep,
willingness to listen and give reassurances, Inge B. Corless
and providing a satisfying diet. Interestingly,
pain relief was not a high priority for patients.
Not only does an approach such as this mea-
sure the discrepancy between patient expec- Hypertension
tations and effectiveness of care, it also has
the potential to evaluate the impact of hospice
care for patients. Hypertension (HTN), also known as high
A concern that enrollment in hospice can blood pressure (Bp), is the most com-
be equated to giving up was not substanti- mon risk factor for cardiovascular disease.
ated in a study by Keyser, reed, lowery, Approximately 74.5 million or one third of
and Sundborg (2010). They conducted a ret- U.S. adults have HTN and another quarter
rospective review of medical records from have pre-HTN, placing them at risk of devel-
2002 to 2008 and concluded that there was oping HTN (lloyd-Jones et al., 2010). Despite
no detrimental effect of hospice on survival improvements since the 1980s in awareness,
of patients with gynecological malignancies treatment, and control of HTN in the United
who accepted and those who declined hos- States, a new diagnosis of HTN shortens an
pice following a recommendation by their individual’s life expectancy an average of 5
provider. Indeed, those with recurrent dis- years because of potential target organ dam-
ease who followed the recommendation for age throughout the cardiovascular system,
hospice care had a longer survival (17 vs. 9 including the heart, the brain, the kidneys,
months). and the eyes (Franco, peeters, Bonneux, & de,
Another example of research that exam- 2005). HTN is anticipated to cost the United
ined the impact of hospice care was that by States a total of $76.6 billion in 2010 (lloyd-
Kabel and roberts (2003), who examined Jones et al., 2010). Globally, 26% of individu-
how the philosophy of hospice providers als are estimated to have HTN, and rates are
influences their perceptions of patient per- rising in many developing countries, result-
sonhood. Specifically, this qualitative study ing in a burgeoning global health problem
examined how hospice staff at two hospice (Kearney et al., 2005).
facilities in northwest england approached current guidelines from the Seventh
“normalizing” the symptoms of terminal report of the Joint National committee