Construction of a Home Hospice Care Program for Older Adults at the End of Life with Chronic Diseases in China: A Delphi Method

Purpose: With the increasing aging of the population and the increasing incidence of chronic diseases in China, home hospice care services can meet the desire of the older adult with chronic diseases to receive care and die at home. In order to ensure the real application of hospice in families, the goal of the study was to construct a home hospice care program for the older adult at the end of life with chronic diseases based on Harmony Nursing Theory (composed of three parts: harmony needs assessment, harmony mechanism establishment and interpersonal interaction). Methods: Through literature review, a qualitative interview and group discussion, the first draft of a home hospice care program for the older adult at the end of life with chronic diseases based on the harmony nursing theory was developed, which was further revised and finalized by combining the Delphi method of expert correspondence with 19 experts and a pilot study with a home hospice care team. Results: A total of two rounds of expert correspondence were conducted. In the first round, 21 questionnaires were distributed and 19 were returned, yielding a recovery rate of 90.48%. In the second round, 19 questionnaires were distributed, and 19 questionnaires were collected. The recovery rate was 100%. The authority of the two rounds of expert correspondence was 0.96, and Kendall’s coefficient of concordance (W) was 0.268 and 0.310, respectively. After the first round of Delphi expert consultation, 3 items were deleted, and 12 items were revised. In the second round of Delphi expert consultation, two items were revised. The final version of the home hospice program includes 4 first-level items, 20 second-level items, and 59 third-level items. Conclusion: The home hospice care program based on harmony nursing theory is authoritative and scientific and can provide a reference for the practice of home hospice care for the older adult with chronic diseases. Keywords: hospice care, older adult, harmony nursing theory, end of life, chronic diseases