Screening and Assessment of Substance Use in Hospice Care: Examining Content from a National Sample of Psychosocial Assessments.

BACKGROUND

Quality of care provided by hospice and palliative care agencies depends on a thorough understanding of the patient, the family, their history, and current risk factors. It is therefore imperative for social workers and other providers in these settings to assess patients and caregivers for substance use disorders and potential for substance misuse.

OBJECTIVE

We aimed to examine how hospice social workers in the United States screen and assess for alcohol and substance use and risk of medication diversion among patients and family caregivers.

DESIGN/MEASUREMENTS: Using a cluster random sample of U.S. Medicare-certified hospices, we reviewed blank copies of psychosocial assessments used by hospice social workers from 105 agencies. We conducted systematic content analyses of these assessments, identifying and examining all items related to substance use or addiction.

RESULTS

Over two-thirds (68%) of agencies assessed substance use by patient and/or family members. Assessments tended to focus broadly on whether substance misuse was a current problem for the patient or his/her primary caregivers. Assessments were not standardized instruments and did not differentiate between drug types. No assessments directly addressed potential diversion of pain medications. Larger hospices serving more patients per day were more likely to include substance use content in their assessments.

CONCLUSIONS

We recommend that hospice care providers implement structured substance use screening focused on both the patients and family. To stem the public health impact of prescription opioid misuse, we recommend adoption of structured screening instruments to evaluate drug diversion risk.