| Patient and caregiver factors |
- Inadequate symptom control (eg, pain; dyspnea).
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- Malfunction or loss of support devices (eg, tracheostomy or gastrostomy tube).
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- Stress, fear, or otherwise inability to cope with impending loss of life.
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- Conflict about life-prolonging treatments. These may be treatments that were discontinued (eg, chemotherapy) or interventions that were never used (eg, hemodialysis).
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- Patients and caregiver(s) have differing philosophies of care.
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- Caregiver fatigue or inability to cope with patient needs.
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- Automatic ingrained response to perceived patient distress.
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| Hospice-related factors |
- Failure or inability to address patient needs in a timely manner.
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- Poor communication with the patient or family.
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- Equipment failure without timely repair or replacement (eg, home oxygen or nebulizer).
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- Call initiated by hospice (eg, unable to provide a specific type of care).
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