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SLU Research Team Receives NIH Grant to Study Live Discharge from Hospice Care

by Maggie Rotermund
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What happens to hospice patients who are discharged from care after their condition stabilizes? A new study from Saint Louis University seeks to evaluate the health and quality of life outcomes for patients and caregivers following live discharge from hospice care. 

Cara Wallace, Ph.D., an assistant professor in the School of Social Work, received a $427,276 grant from the National Institute of Nursing Research of the National Institutes of Health (NIH) to study the needs of patients’ post-hospice discharge and how patients and their caregivers attempt to meet those needs. 

Wallace Grant

The research team, from top left, includes Stephanie Wladkowski, Cara Wallace, Leslie Hinyard and Verna Hendricks-Ferguson, works via Zoom. Submitted photo. 

Hospice care has been shown to improve end-of-life outcomes for adults with chronic illness, yet with eligibility limited, the system is not set up to accommodate longer term needs. Eligibility for hospice requires a patient to forgo curative treatments for his or her terminal condition and a physician to certify life expectancy of six months or less. Those adult patients who stabilize, or have a change in terminal prognosis, may be given a live discharge from hospice care.

In 2017, 6.7%, or nearly 90,000 hospice patients, were discharged after they no longer met eligibility requirements.

“Our study aims to find out what happens to the patient and the caregiver when the patient outlives this prognosis and hospice services are removed,” Wallace said.

Hospice services may include nurse and physician care; physical, occupational or speech therapy; social services; nursing aides, medical equipment and supplies; counseling; and short-term inpatient services. Care is available around the clock, in the patient’s home and is focused on symptom management.

The six-month longitudinal survey will assess the quality of life, service utilization and health status for adult patients and their adult caregiver. The study will evaluate healthcare utilization and health status at time of live discharge and following a live discharge; determine service patterns and the continuity of care transitions; and analyze patient and caregiver perspectives on service coordination and potential impacts to quality of life.

“Without understanding the impact of a live discharge, improving care and providing appropriate support is impossible,” Wallace said. “This is the first step in developing a protocol to create effective live discharge standards.”

The study participants will be referred from hospice agencies affiliated with the Greater St. Louis Hospice Organization, a coalition of independent agencies who meet regularly to foster communication and collaboration. 

Co-investigators include Verna Hendricks-Ferguson, Ph.D., Irene Riddle Endowed Professor in the Trudy Busch Valentine School of Nursing; Leslie Hinyard, Ph.D., director of the Advanced HEAlth Data (AHEAD) Institute and chair of the Department of Health and Clinical Outcomes Research; and Stephanie Wladkowski, Ph.D., associate professor of Social Work at Eastern Michigan University.

The partnership between Wallace and Hendricks-Ferguson was initiated as part of SLU’s Interdisciplinary Health Sciences Research Grant Program. This SLU-sponsored program was supported by the deans of the College for Public Health and Social Justice, School of Medicine, SLU Center for Outcomes Research, Trudy Busch Valentine School of Nursing, Doisy College of Health Sciences, Parks College of Engineering, Aviation and Technology, the College of Arts and Sciences and the Office of the Vice President for Research.

This study is supported by the National Institute of Nursing Research of the National Institutes of Health (NIH), 1R21 NR017978-01A1.

Saint Louis University

Founded in 1818, Saint Louis University is one of the nation’s oldest and most prestigious Catholic institutions. Rooted in Jesuit values and its pioneering history as the first university west of the Mississippi River, SLU offers more than 12,000 students a rigorous, transformative education of the whole person. At the core of the University’s diverse community of scholars is SLU’s service-focused mission, which challenges and prepares students to make the world a better, more just place.