Are we referring patients to hospice too late? Patients' and families' opinions.

Background: Patients typically receive hospice care only in the last days or weeks of life, and there is widespread agreement among experts that patients enroll in hospice too late. However, it is not known whether patients and their families believe that they are enrolling in hospice too late.

Design: Prospective interview study.

Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population?

Background: Hospices provide care to patients with a wide range of prognoses, and must develop care plans that anticipate each patient's likely illness trajectory. However, the tools available to guide prognostication and care planning in this population have limited data to support their use. For instance, one of the most widely-used prognostic tools, the Palliative Performance Scale (PPS), has been studied primarily in inpatient settings and in patients with cancer.

Timing of hospice referral and families' perceptions of services: are earlier hospice referrals better?

Objectives: To determine whether families of patients who enroll in hospice near the end of life believe that they receive less benefit from hospice services than families of patients who enroll earlier.

Design: Semistructured interviews at the time of hospice enrollment and 1 month after the patient's death.

Setting: This study was conducted at the Hospice of Lancaster County, Lancaster, PA, over a 12-month period spanning 2003-2004.