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end-of-life, hospice, patient-centered care



  1. Woods, Landace W. MSN, RN, BC
  2. Craig, Janet B. DHA, RN
  3. Dereng, Nancy BSN, RN, CHPN


The aims of this study were to describe the population of patients 65 years and older admitted to two not-for-profit hospices and the outcomes associated with care processes involved in the transition to hospice care. Both hospices, one part of a large, integrated, multihospital system, and the other a freestanding hospice, are located in the southeastern region of the United States. The Institute of Medicine's recommendations for improvement in the quality of Americans' healthcare served as a framework for exploring the transition of patients to hospice care. Three dimensions, patient-centeredness, timeliness of referral, and accessibility of care, were selected to evaluate the transition to hospice from other settings of care, including identification of the barriers to seamlessness.


A "good death" as defined by the Institute of Medicine is "one free from avoidable distress and suffering for patients, families and caregivers; in general accord with patients' and families' wishes and reasonably consistent with clinical, cultural and ethical standards." The evidence of this investigation at two sites suggests that a significant number of patients transferred to hospice continue to be "late" referrals, have multiple symptoms of distress, and experience problems with coordination between providers. Addressing barriers to seamless transitions for the frail elderly patients has the potential to improve patients' and families' experience of a good death. The findings of this investigation, the first step in area-wide performance improvement efforts, support the need for continuing the exploration of interventions to improve end-of-life care.