Date of Conferral

2021

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Edna Hull

Abstract

Despite scientific evidence suggesting that hospice care improves quality of life (QOL) at end of life (EOL), terminally ill patients are being referred to hospice too late. A considerable number of terminally ill patients are referred directly from the inpatient unit. Often, these patients have not had a goal-of-care conversation (GOC) with their primary care provider (PCP) nor have they been offered hospice care until hospitalization. It is imperative that PCPs, advocate and support patients and families during all stages of life including EOL. This doctoral project was completed for the purpose of identifying strategies used by PCPs that enhance timely hospice referrals. Guided by Kolcaba's theory of caring, a systematic literature review was conducted using the Joanna Brigg's Institute Systematic Review process and the Preferred Method Items for Systematic Reviews and Meta-Analyses (PRISMA). Following PRISMA guidelines, eight evidence-based sources were included in the review. All publications met the inclusion criteria of sources written between 2010 to 2020, strategies used by PCPs that enhance timely referrals to hospice, original studies, cancer and non-cancer diagnosis, and articles written in English. Reported in themes, findings from the literature indicate that provider training and healthcare staff education, nurse-led strategies, patient and family teaching, academic education and research, and specialist support are current strategies used to enhance timely referrals of patients for hospice care. Implications of positive social change include improving quality of care at EOL, customer satisfaction, and creating a culture that is confident, competent, and open to engaging in difficult conversations about GOC at EOL.

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