2.  Cases of the Jensons and Matthews  Brief Review of Literature  Methodology  Findings  How to Help Families Be Ready for Hospice  Future Studies

8.  Gaps in literature related to the decision making process for hospice and end of life care  There is limited research about what makes a family ready to enroll in hospice

9.  End of Life Communication and Involvement of Health Care Professionals (Csikai, 2006; Cassarett, Crowley, & Hirschman, 2004)  Factors which affect hospice utilization (Haley et., 2002; Zhang & Siminoff, 2003)

10.  Sample of Convenience  Two focus groups - - key informants -- family members  Three individual interviews -- two doctors -- one pastor

11. 16 participants six family members seven participants in the key informants three key informant individual interviews

12.  Gender › 5 males › 11 female  Ethnicity › 12 Caucasian › 2 African American › 2 Hispanic  Professions › 4 nurses › 3 social workers › 2 doctors › 1 pastor

13.  Role of Doctor in Explaining Terminal Illness > Need face-to-face conversation > Important how hospice is explained > Understandable terminology

14.  Lack of Education and Negative Perceptions › Knowing someone who utilized hospice › Educate health care professionals › End-of-life discussions

15.  Religious Beliefs > Christians more willing > Impacts decision > Minister and church community important > Same faith= differing views

16.  Cultural Beliefs › African American › Hispanic › Asian

17.  Family Support*  Duration of Care giving*  Physical Decline*  Acceptance of Terminal Illness* *handout

18.  Age of patient*  Gender of Primary Caregiver*  Trusting relationship with doctor or hospice staff*  Previous discussion about end of life issues*

19.  Combining qualitative methods provides more comprehensive review  Multiple factors were confirmed  Fills gap

20.  Results can not be generalized  Group was not culturally diverse  Unable to gain information from families who did not choose hospice

21.  Negative Perceptions --Point out support family provides --Identify hospice as a support --Focus on the family strengths  Extend boundaries of support

22.  Sole/primary caregiver?  Physical help?  Concerns about progression of the illness?

23.  Spiritual or cultural beliefs?  Comfort medications?  End-of-life issues?  Receiving help?

24.  Impact of religious and cultural beliefs  Compare readiness to enroll compared to utilizing hospice services  Test reliability and validity of assessment tool  Quantitative research on what factors determine a family’s readiness for hospice

26.  Casarett, D. J., Crowley, R. L., & Hirschman, K. B. (2004). How should clinicians describe hospice to patients and families? Journal of the American Geriatrics Society, 52(11), 1923-1928.  Cherlin, E., Fried, T., Prigerson, H. G., Schulman-Green, D., Johnson-Hurzeler, R., & Bradley, E. H. (2005). Communication between physicians and family caregivers about care at the end of life: When do discussions occur and what is said? Journal of Palliative Medicine, 8(6), 1176-1185.  Csikai, E. L. (2006). Bereaved hospice caregivers' perceptions of the end-of -life care communication process and the involvement of health care professionals. Journal of Palliative Medicine, 9(6), 1300-1309.  Grange, C. M., Matsuyama, R. K., Ingram, K. M., Lyckholm, L. J., & Smith, T. J. (2008). Identifying supportive and unsupportive responses of others: Perspectives of African American and caucsasian cancer patients. Journal of Psychosocial Oncology, 26 (1), 81-99.

27.  Haley, W., Allen, R., Reynolds, S., Chen, H., Burton, A., & Gallegher -Thompson, D. (2002). Family issues in end-of-life decision making and end-of-life care. American Behavioral Scientist, 46 (2), 284-298.  Jnowiak, S. M. (1995). Bereavement experiences of African-Americans: The use of focus groups. Psy.D. Dissertation, Indiana University of Pennsylvania, United States- Pennsylvania.  Lambert, S. D. & Loiselle, C. G. (2008). Combining individual interviews and focus groups to enhance data richness. Journal of Advanced Nursing, 62(2), 228-237.  Ogle, K. S., Mavis, B. & Wyatt, G. K. (2002). Physicians and hospice care: Attitudes, knowledge, and referrals. Journal of Palliative Medicine, 5(1), 85-92.  Zhang, A. Y., & Siminoff, L. A. (2003). The role of the family in treatment decision making by patients with cancer. Oncology Nursing Forum, 30(6), 1022