Late Hospice Enrollment: An Action Research Stud

This action research study explored the problem of late hospice enrollment. Hospice is a health care program for patients diagnosed with an incurable disease. The goal of hospice staff is to create conditions for a dignified and pain-free end-of-life experience. Timely enrollment is essential for creating such conditions. One rural hospice program identified that late enrollment interfered in the staff's ability to deliver effective treatment for a good death experience. In this action research study, staff from this hospice program sought to find an explanation for late enrollment. Hospice staff maintained that earlier hospice enrollment strengthened the likelihood for the delivery of effective treatment. Both hospice staff and scholarly research indicated that effective treatment was more likely to be associated with a pain-free and dignified death experience. Through individual, semistructured interviews, eight hospice staff shared perspectives and experiences that described the problem as it occurred in their work setting. A research journal and examination of program artifacts and documents also contributed contextual data. Drawn from grounded theory analysis, constant comparison and contrast identified three themes. The theoretical premises for translating the themes of functioning, readiness, and quality were complexity theory, social constructionism theory, and role theory. Findings indicated that hospice staff was able to create interventions that specifically targeted the problem of late enrollment as it occurred in their program. Hospice staff made two immediate changes: modification of the policies and procedures for delivery of services and the revamping of the program's main brochure. Additionally, administrators introduced transformational leadership strategies. These and other planned changes resulted from hospice staff voicing a sense of empowerment to correct the problem of late hospice enrollment.