Document Type



Doctor of Philosophy (PhD)


Social Work

First Advisor's Name

Nicole Ruggiano

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Miriam Potocky

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Barbara Thomlison

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Ellen Brown

Fourth Advisor's Committee Title

Committee Member


Hospice, Psychosocial, Social Work

Date of Defense



Information has been sparse on the hospice psychosocial support offered through the American hospice system. This study examined the hospice psychosocial services that are available and utilized within the United States. In addition, the characteristics of patients and families who utilized these services were comprehensively assessed. Data from the 2007 National Home and Hospice Care Survey (NHHCS) was analyzed in this cross-sectional study (National Center for Health Statistics [NCHS], 2007). Hierarchical linear regression, hierarchal logistic regressions as well as chi-square test of independence were used to analyze the data.

It was hypothesized that for profit hospice ownership status would predict less availability and utilization of psychosocial services when agency size, chain status, and patient total activity of daily needs are controlled. Ownership status was a significant predictor of medical social service availability where for profit agencies were more likely to have this service available. Conversely, hospice patients at for profit agencies were less likely to utilize medical social services as well as bereavement services.

Overall, patient and caregiver utilization rates of psychosocial services were low with the exception of medical social services, bereavement services, spiritual care services, & safety training services. The majority of individuals that used these services were married, White, non-Hispanic, 74-75 year old cancer patients with no cognitive impairment. Most were Medicare recipients with advanced directives in place and had 4 ADL needs. Routine home care patients with an average care continuum of about 2-2 ½ months accounted for most of those who used these services. The majority of these patients lived in a private residence with family members and had spousal caregivers.

These results suggest that the psychosocial services that are being provided have an overall low utilization rate despite availability regardless of ownership type. Further, psychosocial services are disproportionately underutilized by racial and ethnic minorities. In addition, these results highlight the disparity that exists between racial groups that are admitted under hospice care. Further interdisciplinary research needs to be conducted in order to address this disparity in order to determine alternative forms of care that are specifically tailored to a diverse patient population.



Included in

Social Work Commons



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