What happens in hospices: a review of research evidence.

The growth of the modern hospice movement has been accompanied by some evaluative research, although this has been pursued with greater vigour in the United States than in Britain. Most studies employ the method of outcome measurement (patient or carer satisfaction for example) and only incidentally report on processes occurring within hospices or hospitals. A review of the research evidence suggests that processes of patient care may not always be very different between hospices and hospitals. This may be because hospital staff have learned from the example of hospices, but may also be due to hospice staff associated with traditional care systems compromising their ideals. Evidence from evaluative and from participant observation studies is reviewed to examine differences between hospital and hospice care in five major areas: medical therapies, psychosocial care, disclosure of prognosis, carers' involvement, in-patient care and relations between staff. The quality and scope of the research evidence in many instances needs extending. The relevance of a hospice approach to non-cancer patients is discussed and priorities for future research on the process of hospice care are outlined.