Research Article
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Published Online: 25 October 2024

“Who You Are and Where You Live Matters”: Hospice Care in New York City During COVID-19
Perspectives on Hospice and Social Determinants: A Rapid Qualitative Analysis

Publication: Journal of Palliative Medicine

Abstract

Context: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience.
Objective: To examine hospice professionals’ perspectives of how SDOH affected the delivery of high-quality home hospice care in New York City (NYC) during the COVID-19 pandemic.
Methods: We conducted semistructured interviews with 30 hospice professionals who delivered care to home hospice patients during the COVID-19 pandemic in NYC using a qualitative descriptive design. Purposive sampling was used to recruit professionals from a range of disciplines including physicians, advanced practice providers, nurses, social workers, chaplains, and hospice administration and management. Participants worked for one of two large NYC metro hospices and one outpatient palliative care practice serving the five boroughs of NYC and the surrounding suburbs. Rapid qualitative analysis was used to identify themes.
Results: Thirty hospice professionals were interviewed, spanning a variety of clinical and administrative roles. Most (21 out of 30) reported that social determinants affected access and/or delivery of equitable hospice care. Two key themes emerged from interviews: (1) SDOH exist and affect the delivery of high-quality care and (2) disparities were exacerbated during the COVID-19 pandemic resulting in barriers to care. Subthemes outline barriers described by hospice professionals: decreased hospice enrollment, telehealth challenges, resulting in deficient patient/family education, shortages of nursing assistants in some neighborhoods, and diminished overall quality of hospice care for some patients. SDOH created barriers to hospice care through neighborhood factors, resource barriers, and system challenges.
Conclusion: SDOH provide a context to understand disparity in the provision of hospice care. COVID-19 exacerbated these conditions. Addressing multidimensional barriers created by SDOH is key in creating high-quality and equitable hospice care, particularly during a crisis.

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Information & Authors

Information

Published In

cover image Journal of Palliative Medicine
Journal of Palliative Medicine

History

Published online: 25 October 2024
Accepted: 19 September 2024

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Authors

Affiliations

Daniel David [email protected]
NYU Rory Meyers College of Nursing, New York, New York, USA.
NYU Hartford Institute of Geriatric Nursing, New York, New York, USA.
Laura T. Moreines
NYU Rory Meyers College of Nursing, New York, New York, USA.
NYU Hartford Institute of Geriatric Nursing, New York, New York, USA.
Jonelle Boafo
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Emily Franzosa
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Dena Schulman-Green
NYU Rory Meyers College of Nursing, New York, New York, USA.
NYU Hartford Institute of Geriatric Nursing, New York, New York, USA.
Abraham A. Brody
NYU Rory Meyers College of Nursing, New York, New York, USA.
NYU Hartford Institute of Geriatric Nursing, New York, New York, USA.
NYU Grossman School of Medicine, New York, New York, USA.
Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Notes

Address correspondence to: Daniel David, PhD, MS, RN, NYU Rory Meyers College of Nursing, 433 First Ave, Room 422, New York, NY 10010, USA [email protected]

Author Disclosure Statement

There are no conflicts of interest relevant to this work.

Funding Information

Preparation for this article was supported in part by grants from the National Institute of Nursing Research to Dr. Aldridge (R01NR019792).

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