Timing of Survey Administration after Hospice Patient Death

Stability of Bereaved Respondents

Eleanor L. Dibiasio, Melissa A. Clark, Pedro L. Gozalo, Carol Spence, David J. Casarett, Joan Teno

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Context The Centers for Medicare & Medicaid Services have elected to include a bereaved family member survey in public reporting of hospice quality data as mandated in the Affordable Care Act. However, it is not known what time point after death offers the most reliable responses. Objectives To examine the stability of bereaved family members' survey responses when administered three, six, and nine months after hospice patient death. Methods Bereaved family members from six geographically diverse hospices were interviewed three, six, and nine months after patient death. All respondents completed a core survey. Those whose family member died at home, in a freestanding inpatient unit, or in a nursing home also completed a site-specific module. Stability was based on top-box scoring of each item with kappa statistics, and multivariable regression models were used to assess directionality and predictors of change. To analyze the effects of grief, we assessed response stability among respondents at least one SD from the mean change in grief between three and six months. Results We had 1532 surveys (536 three-month surveys, 529 six-month surveys, and 467 nine-month surveys) returned by 643 respondents (average age 61.7 years, 17.4% black, and 50.5% a child respondent) about hospice decedents (55.3% females, average age 78.6 years, 57.0% noncancer, and 40.0% at home). The average kappa for core items between three and nine months was 0.54 (range 0.42-0.74), 0.58 (0.41-0.69) for home-specific items, and 0.54 (0.39-0.63) for nursing home. Even among individuals demonstrating large grief changes, core items demonstrated moderate to high stability over time. Conclusion Bereaved family member responses are stable between three and nine months after the death of the patient.

Original languageEnglish (US)
Pages (from-to)17-27
Number of pages11
JournalJournal of Pain and Symptom Management
Volume50
Issue number1
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

Fingerprint

Hospices
Grief
Nursing Homes
Surveys and Questionnaires
Medicaid
Medicare
Inpatients

Keywords

  • bereavement
  • grief
  • Hospice
  • quality measurement
  • response stability

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Timing of Survey Administration after Hospice Patient Death : Stability of Bereaved Respondents. / Dibiasio, Eleanor L.; Clark, Melissa A.; Gozalo, Pedro L.; Spence, Carol; Casarett, David J.; Teno, Joan.

In: Journal of Pain and Symptom Management, Vol. 50, No. 1, 01.07.2015, p. 17-27.

Research output: Contribution to journalArticle

Dibiasio, Eleanor L. ; Clark, Melissa A. ; Gozalo, Pedro L. ; Spence, Carol ; Casarett, David J. ; Teno, Joan. / Timing of Survey Administration after Hospice Patient Death : Stability of Bereaved Respondents. In: Journal of Pain and Symptom Management. 2015 ; Vol. 50, No. 1. pp. 17-27.
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abstract = "Context The Centers for Medicare & Medicaid Services have elected to include a bereaved family member survey in public reporting of hospice quality data as mandated in the Affordable Care Act. However, it is not known what time point after death offers the most reliable responses. Objectives To examine the stability of bereaved family members' survey responses when administered three, six, and nine months after hospice patient death. Methods Bereaved family members from six geographically diverse hospices were interviewed three, six, and nine months after patient death. All respondents completed a core survey. Those whose family member died at home, in a freestanding inpatient unit, or in a nursing home also completed a site-specific module. Stability was based on top-box scoring of each item with kappa statistics, and multivariable regression models were used to assess directionality and predictors of change. To analyze the effects of grief, we assessed response stability among respondents at least one SD from the mean change in grief between three and six months. Results We had 1532 surveys (536 three-month surveys, 529 six-month surveys, and 467 nine-month surveys) returned by 643 respondents (average age 61.7 years, 17.4{\%} black, and 50.5{\%} a child respondent) about hospice decedents (55.3{\%} females, average age 78.6 years, 57.0{\%} noncancer, and 40.0{\%} at home). The average kappa for core items between three and nine months was 0.54 (range 0.42-0.74), 0.58 (0.41-0.69) for home-specific items, and 0.54 (0.39-0.63) for nursing home. Even among individuals demonstrating large grief changes, core items demonstrated moderate to high stability over time. Conclusion Bereaved family member responses are stable between three and nine months after the death of the patient.",
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