How do Hospice Patients Feel about Hospice Care - and is It Important? Exploring the Relationship between Patient Attitude to Hospice Care, Survival and other Patient Characteristics in the Setting of First Croatian Hospice (Original paper)

Objective: To research the relationship between the initial attitude of hospice patients towards hospice care and different patient characteristics. Design: Retrospective chart review. Participants: 433 consecutive patients with the determined attitude towards hospice care, in the first Croatian hospice, the Marija K. Kozulic from March 2013 to March 2016. Methods: We evaluated the relationship between patient attitude towards hospice care and characteristics such as age, gender, marital status, level of education, the presence of cancer, performance status, initial and final opioid dose, the use of anxiolytics and antipsychotics, fluid intakes, participation in physiotherapy, discharge status and survival in hospice. Results: Patients were divided into four different groups based on their attitude towards hospice care: acceptance, rejection or anger, depression, bargaining or adapting, and uninformed or partially informed. Our research shows that the majority of patients (69%) has a positive attitude towards hospice. There were no significant differences regarding age, gender, marital status, as well as survival and discharge status between the groups. However, patients exhibiting depression, bargaining or adapting had significantly higher opioid doses in therapy (on average, 145.8 mg OME/day), and the highest elevation of opioid doses during their stay (on average, 52 mg OME/day) compared to other groups. Conclusion: Most patients have a positive attitude towards hospice care. However, the differences in attitude might not influence the length of survival or discharge percentage. However, patients exhibiting depression, bargaining or adapting might be in risk of over-treatment with opioids and could potentially gain significant benefits from the addition of anti-depressants, or sessions with a psychologist