A comparison of hospice and hospital: care goals set by staff

Abstract

It has been suggested an important difference between hospice and hospital care is that hospice care is more geared to the attainment of patient and family goals, and that these goals concern a broader range of comfort, psychosocial, and rehabilitation issues. This study investigated whether such differences exist. Structured interviews were conducted with doctors and nurses in two NHS hospices, and three medical and two surgical wards of a district general hospital (DGH), to ascertain their goals of care and treatment for random samples of newly admitted terminally ill cancer patients (29 in the DGH and 29 and 28 in the hospices). DGH doctors set fewer goals in total, dealing with fewer issues, than hospice doctors or DGH nurses, and took longer to do so. Hospice and DGH nurses did not differ in the number or content of goals set, or speed of goal setting. DGH doctors set fewer goals concerning rehabilitation and the patient's emotional state than hospice doctors or DGH nurses, and fewer goals concerning patient-family relationships and the family's emotional state than hospital nurses. The hypothesis that hospice care is more 'goal-oriented' than hospital care is supported in relation to doctors, but not nurses. The staff's follow-up assessments showed greater perceived success in one hospice than the other hospice or the DGH. The optimism of nurses' and doctors' goals was similar from the outset in one hospice, became similar in the other hospice, but diverged in the DGH, with the nurses setting less optimistic goals after the first week. These differences illustrate poorer communication between DGH staff than hospice staff about what they were trying to do for their patients. To parallel the hospices' approach, DGH doctors should heed the views of their nursing colleagues and attend more positively to their patients' rehabilitation and emotional needs, to patient-family relationships and to the families' emotional needs.

Keywords

motivation organizational objectives palliative treatment terminal care

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