Understanding enrollment conversations: the role of the hospice admissions representative.

Nonparticipant observation was undertaken to understand how barriers are discussed and managed in initial hospice enrollment conversations between patients, families, and hospice admission representatives. The first author observed patient/family and hospice admission representative interactions, interviewed hospice admission representatives, and attended monthly hospice meetings for a total of 37 hours of observation. Findings indicate that patients and a primary family member take on particular roles during these initial conversations. Based on the roles adopted by the patient and the family, the hospice admission representative engaged in 1 of 3 types of talk: (1) enrollment talk, (2) reassurance talk, or (3) informative talk. When engaging in enrollment conversations with families, hospice admission representatives direct their comforting statements toward reappraising uncertainty about hospice and uncertainty about death and dying.