"My Preference would be to be at Home": Patients' Experiences of their Hospice at Home Care

Abstract

A specialist 'Hospice at Home' (HaH) service commenced in 2006 in Mid West Ireland whereby participants received palliative care from a specialist team in their own home. An independent team was commissioned to evaluate the key stakeholders' perspectives of this service including patients, carers and staff. This original paper presents the findings from the patients receiving the HaH service. Objective: The investigation aimed to examine the experiences of patients receiving Hospice at Home care from a new multidisciplinary palliative care team. Method: Possible participants were drawn from the clinical register and screened for suitability. Fifteen participants were selected and interviewed using a structured interview schedule; interviews were transcribed and subjected to thematic analysis. Results: Overall, participants' experiences of the service were positive with quality of care being highly rated. Participants regarded the service as supportive and responsive, particularly in relation to pain management and symptoms. Excellent communication and interpersonal skills from Hospice at Home staff members were highlighted. Overall, participants rated their own quality of life as high; although this cannot be attributed to the HaH service alone. Although not explicitly asked about, the possibility of being a burden to family remains an issue for those being cared for at home. The majority of participants were very satisfied with the service enabling them to be cared for at home. Areas for future improvements to the HaH service emerged, including discussions about advanced care directives, access and method of referral to the Hospice at Home service and patients' understanding of the service being delivered. Conclusion: The Hospice at Home Service supported participants in facilitating their choice to be care for and to die at home. However, discussion with patients, family and HaH staff is recommended concerning place of death and the range of services provided by the HaH.