Kristopher Fennie

Translation of a Hospice in Prisons Model to a VA Setting

We propose a feasibility study to translate a successful Hospice in Prisons model of end-of-life care developed in the Connecticut prison system to the VA setting, namely at Rocky Hill VA Hospital. This model teaches fellow inmates to become hospice care givers and provide support for inmates who are dying. It has the advantage of helping to improve the quality of life, self-efficacy, and feelings of adequacy in both care provider and the one dying. We will translate this model whereby fellow veterans would become hospice volunteers.

The specific aims are as follows

1. To collect data on a sample of veterans regarding their thoughts and feelings on death and dying, their feelings on religion and spirituality, and their family and social support networks which will be compared to data collected from the Hospice in Prisons program.
2. To determine the general interest and acceptance among staff and patients of a peer driven hospice care model within Rocky Hill VA;
3. To translate the curriculum for training and the role activities in care giving from the prison model into a VA model.

We will survey 70 veterans at Rocky Hill Veterans State Home. We will recruit both residents of the domicile and hospital patients. We will collect information on (i) veterans thoughts about death and dying (including FDD scale, Epstein 1975), (ii) family and social support (NSSQ), (iii) feelings about religion and spirituality, (iv) their health (including SF-36), (v) depression CES-D, (iv) and trust in provider (HCR Trust). We will compare these data with those collected from the Hospice in Prisons program baseline data to determine similarities, as well as to assess appropriateness of the already developed educational materials and protocols.

We propose to clarify the underlying concepts germane to hospice and palliative care within the prison system. This will be done with three activities: 1. Interviews with staff nurses, clinicians, and administrative personnel at Rocky Hill. 2. Conduct focus groups composed of veterans to ascertain their thoughts on death and dying, of hospice care in the VA setting, and willingness to be or have a veteran hospice volunteer help to manage the care of a dying person. 3. Individual interviews with terminally ill veterans at Rocky Hill to identify concerns about dying that they have, and their thoughts on the idea of fellow veterans helping with their care. The results from the above data will help us to translate the curriculum for training peer-run hospice care in the VA setting.

This proposal, project, and overall program of research is consistent with the Yale School of Nursing's mission of a 'diverse community with one goal: Better health care for all.' This model, if successful, will help to bring palliative and hospice care of veterans to an equal, if not better, footing with the private sector. This project involves translation of research into practice, to transform health and health care with special attention to eliminating health care disparities in Veterans. This program, borne from the work of Florence Wald, continues to demonstrate Yale School of Nursing's leadership in scholarship as we continue to be on the forefront of the hospice movement.

Funded by the Beatrice Renfield-Yale School of Nursing Clinical Research Initiatives Fund

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