A Survey of Home Hospice Staff Knowledge of Suicide Risk Factors,Evaluation,and Management

Background

Patients with chronic or advanced disease are at risk for suicidality. ¹ Given this vulnerability, hospice staff should be able to evaluate and manage suicidal ideation.^2–4 The purpose of this study was to survey hospice staff who conduct home visits to determine their level of training in mental health and ability to manage a suicidal patient.

Method

The study used a cross-sectional survey design conducted at an academic nonprofit hospice in southwest Pennsylvania with an average daily census of 350 patients. The survey asked general information about participants' specialties, years in hospice, and years working with their current employer. Questions about suicide included management of potentially suicidal patients. The survey was distributed through e-mail with an anonymous link to the survey to maintain confidentiality. The study was approved by the Institutional Review Board at the University of Pittsburgh.

All survey responses of interest were categorical in nature and were summarized with frequencies and percentages. Cross-tabulations showed relationships between responses, and statistical significance was tested using a two-sided Fisher's exact test. Statistical significance was set at p < 0.05. All statistical analyses were conducted in IBM SPSS version 22 (IBM Corp., Armonk, NY).

Results

A total of 121 individuals were eligible to participate in the survey. Eighty-seven (72%) completed the survey. Participants included 44 registered nurses (56%), 9 licensed practical nurses (10.3%), 22 certified nursing assistants (CNAs) (25.3%), 9 social workers (SW) (10.3%), and 3 chaplains (3.4%).

The majority (71.3%) received education in mental health during their specialty training but 25.3% had not. Less than half (51.7%) of the staff had not received mental health training from the hospice. Forty-five percent of CNAs received no mental health training.

There was a difference in the responses of the CNAs compared with those of other specialties regarding how they would screen potentially suicidal patients (Table 1). Education and experience also influenced stated behavior. Staff with more than one year of experience in hospice were more likely to ask direct questions about suicidal ideation. Similarly, staff who had had mental health training were more likely to ask about plans and means of suicide, presence of a firearm in the home, and previous suicide attempts.

Discussion

To our knowledge, this is the first study to look at staff knowledge of mental health and management of suicidal patients. We found deficiencies in the training and knowledge of hospice providers regarding suicidal patients particularly among the CNAs. It was encouraging that mental health training correlates with asking questions.

Conclusion

In this article, we demonstrate that variations exist among hospice care providers in their level of knowledge about mental health and suicide. For staff, particularly CNAs, more training is needed as these staff work intimately with patients. Curriculum development efforts should focus on this group, and future research studies should examine the outcomes and determine whether the number of patients identified to be at risk for suicide increases after the educational intervention.