Hospice employees may witness death and terminal sickness almost every day, but it does not mean they have recorded their own wishes and will, a new report finds.
A poll of nearly 900 healthcare workers at a Florida hospice discovered that over half -- just 44 percent -- had completed advance directives. Of the remainder, 52 percent said they hadn't filled out the forms that define choices. Almost 4 percent said that they were not sure when they had or not.
That surprised Dr George Luck, a palliative medicine specialist at the Charles E. Schmidt College of Medicine at Florida Atlantic University, who led the research.
Luck expected more from people who utilize the even though the proportion is greater than the approximately one-third of Americans that have advance directives in place.
"I expected people who are employed in a hospice setting, who see what happens when someone does not have an advance directive, the way that may be a battle for the household, a larger burden," to be better prepared, stated Luck. The study was written in the American Journal of Medicine.
Equally surprising was that about 10 percent of hospice workers without directives stated they did not know where to acquire the types -- which are widely available on the internet. Another nearly 6 percent said cost was a barrier, even though the documents can be completed without the help of an attorney, at no cost.
"I don't require everybody to have an advance death will, but at least understand the fundamentals," Luck said. "Basically, you can write it on a napkin in the event that you wanted to."
Approximately 7 percent of employees said fear of the topic kept them '' he explained.
Luck and his colleagues sent surveys annually to nearly 2,100 employees at Trustbridge, a hospice in Boca Raton, Fla., which serves about 2,000 patients. The 890 people who responded included physicians, nurses, clergy, office employees, volunteers and others.
Whether they had completed advance directives varied by age and ethnicity. Almost 60 percent of workers had filled the records out, compared with about 30 percent of Hispanics, 22 percent of African-Americans and 14 percent of Asians, the study revealed.
Volunteers and physicians were most inclined to have advance directives, with 60 percent saying they'd records in place, compared to about 20 percent of licensed nursing assistants.
That was probably linked to age, Luck said. Doctors and volunteers tended to be older than the CNAs. The forms had been filled out by nearly 80 percent of employees older than 65, compared with about 25 percent of those 40 and younger.
It didn't appear to matter whether employees cared for patients that are dying. Approximately 46 percent of those who spent over 75 percent of the time had directives, about the same as those with no interaction.
It's getting better, although the proportion of Americans overall who place their wishes in writing is low. In 1990, directives had been completed by only 16 percent of individuals who reacted to a Pew Research Center study. By 2013, that number rose to 35%.
Still, the new study shows the reluctance of many individuals to address their mortality, '' said Jon Radulovic, a spokesman for the National Hospice and Palliative Care Organization (NHPCO).
"It's a reminder that hospice professionals, despite the fact that they deal with death and dying among the families and patients that they care for, are still people who do not think their deaths might be impending," Radulovic stated in an email.
Everyone can fill out an advance directive, stated Luck. Once completed, the forms could be shared with caregivers and kept with documents. An NHPCO program called CaringInfo.org offers free, state-specific advance directive forms, and a manual for having end-of-life conversations.
Better education is the key, Luck said. And it's possible that hospice workers may only need a nudge. 43 percent of those without documents said they planned to fill the forms out following the Florida team members took his poll.