Exploration of the decision-making process for inpatient hospice admissions

Aim. This paper discusses some of the findings of a qualitative study which described the decision-making processes that occurred during multidisciplinary meetings when prioritizing hospice inpatient admissions. Background. Healthcare rationing and resource allocation have been identified as important but under-represented issues in the British nursing literature generally, and specifically within the field of palliative care. Little evidence currently exists about the rationing decisions made at a clinical level in hospices or palliative care units. Method. Adopting an ethnographic approach, data were collected at three hospice sites from three meetings at each site by observation, tape recording and transcribing of the meeting dialogue and examination of the available documentation from admissions meetings. The data were collected in 2002. Results. Factors identified as potentially influential in these decisions included patient diagnosis, symptoms, current location and the stated reason for admission. The person who had assessed the patient's need for admission and whether or not a patient was personally known to a clinician present at the meeting also appeared important. The process seemed complex and incorporated different decision-making methods. Analysis of the group interactions suggested that these meetings were predominantly medically-led. Conclusion. Palliative care nurses need to examine their beliefs and practices in relation to how hospice inpatient care is prioritized, and develop sound evidence-based arguments in order to strengthen their role and influence in these important decisions for the benefit of patients. Further research is needed to achieve a greater understanding of these types of decision-making processes.