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Opting Out of a Time-of-Death Visit

Insights From Home Hospice Family Members

Katzenberger, Katherine S. MN, RN, CHPN; Nichols, Michelle PhD, RN

Journal of Hospice & Palliative Nursing: August 2019 - Volume 21 - Issue 4 - p 326–332
doi: 10.1097/NJH.0000000000000546
Feature Articles

Hospice patients die in various settings, including at home with family caregivers. Hospice offers a time-of-death visit to provide support and confirm death, a requirement in some states but not all. Few studies have been conducted among home hospice families exploring their experiences without a time-of-death visit. To better understand the family’s experience regarding the time of death of their loved one, we conducted an exploratory study using a hermeneutic phenomenological approach. Home hospice families who had experienced a death within the last 6 to 13 months and had not received a time-of-death visit were recruited. Seven interviews were conducted, and data were analyzed using an emergent thematic approach. Major themes included caregiver’s previous experience with death, caregiver support, final hours, and reasons for not selecting a time-of-death visit. Results showed families did well without a time-of-death visit when strong social support was present and conveyed the importance of allowing personal choice. Further research is needed to identify families in need of time-of-death visits and targeted support needs and to inform practice and policy guidelines.

Katherine S. Katzenberger, MN, RN, CHPN, is manager, EvergreenHealth Hospice, Kirkland, Washington.

Michelle Nichols, PhD, RN, is assistant professor, College of Nursing, Medical University of South Carolina, Charleston.

Address correspondence to Katherine S. Katzenberger, MN, RN, CHPN, EvergreenHealth Hospice, 12040 NE 128th St, MS 119, Kirkland, WA 98034 (

The authors have no conflicts of interest to disclose.

Online date: April 8, 2019

© 2019 by The Hospice and Palliative Nurses Association.