부산대학교 도서관

1. Upon successful completion, participants will be able to describe the current state of the science related to interventions and predictors that lead to hospice transitions for persons living with dementia. 2. Upon successful completion, participants will be able to understand gaps in the evidence related to hospice transitions and recommendations for future research. This review was conducted to examine interventions and predictors of hospice transition across settings for people living with dementia. While interventions focused on hospice decision-making are available, they are limited in number, scope, sample size, and racial and ethnic diversity. Hospice transitions occur late in illness trajectories for people with dementia and the evidence base is severely limited. When aligned with goals of care, persons living with dementia (PLWD) benefit from transition to hospice care at the end of life. However, interventions and predictors that facilitate high-quality, goal-concordant transition to hospice are understudied. This state-of-the-science review appraised evidence related to implemented interventions and predictors that lead to hospice transition for PLWD across healthcare settings and identified gaps to inform future research. Five databases were systematically searched (e.g., PubMed, CINAHL, Web of Science, Google Scholar, Cochrane Database for Systematic Reviews) for articles between 2000 and 2023. Search terms included MeSH terms and keywords focused on dementia, hospice care, transitions, care management, and/or coordination. After critical appraisal, 15 articles met inclusion criteria: 6 retrospective cohort studies; 3 secondary data analyses; 2 randomized control trials; 2 qualitative descriptive studies; 1 feasibility study; and 1 survey. Most were cross-sectional in design and centered around nursing home and hospital-based care in the US and Europe. The average age of PLWD and caregivers was 85.3 and 57.7, respectively. PLWD had multiple chronic conditions including cancer, diabetes, heart disease, and stroke. Interventions inclusive of hospice decision-making were delivered through video-assisted advance care planning and checklist-based care management and triggered palliative care for those with late-stage dementia. Predictors included increasing severity of illness including multisystem organ failure, transition to intensive care, do not resuscitate and life-sustaining treatment orders, insurance status, race and ethnicity, and caregiver burden. Overall, despite moderate to high-quality evidence, the studies were limited in scope and sample and lacked racial and ethnic diversity. This review highlights current evidence exploring interventions and predictors of hospice transitions. Prospective, multisite randomized trials and population-based analyses including larger and diverse samples, are needed for improved end-of-life care transitions for PLWD and their caregivers. Shared Decision Making / Advance Care Planning; Disease specific management [ABSTRACT FROM AUTHOR]