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Factors Associated With Hospice Use After Referral

Forcina Hill, Jill M. BSN, RN, OCN, CHPN

Journal of Hospice & Palliative Nursing: July-August 2008 - Volume 10 - Issue 4 - p 240-525
doi: 10.1097/01.NJH.0000319151.80445.41

The Behavioral Model of Hospice Use, a newly developed model for the study of hospice utilization, was used to guide this preliminary study examining factors associated with hospice use after referral. Information on 614 referred hospice patients was extracted from a home hospice database, including individual patient demographics, hospice enrollment status, and reported reasons for not enrolling in hospice. Race was the only predictor of enrollment in hospice based upon results from the backward regression model (P = .010). Whites were more likely to enroll than nonwhites. Nonwhite patients were more likely to not use hospice because of prognosis-driven reasons than whites after adjusting for gender, age, diagnosis, insurance, and marital status (P = .044). The findings indicated that racial and ethnic disparities in hospice use may be related to institutional rules and regulations, rather than patient preference, and the racial/ethnic disparities in health and healthcare services.

Author Affiliations:Jill M. Forcina Hill, BSN, RN, OCN, CHPN, is a Hospice Nurse and a Doctoral Candidate, University of North Carolina at Chapel Hill.

The abstract of this article was presented at the 2008 AAHPM/HPNA Annual Assembly; January 30 to February 2, 2008; Tampa Bay, Florida.

This study was completed as a precursor to the author's dissertation and was supported by Interventions for Preventing and Managing Chronic Illness (grant #T32 NR07091) and the Ruth L. Kirschstein National Research Service Award (grant #F31 NR010185-01).

Address correspondence to Jill M. Forcina Hill, BSN, RN, OCN, CHPN, University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC 27599 (

© 2008 The Hospice and Palliative Nurses Association