The primary mission of hospice agencies is to provide quality end-of-life care to patients, families and communities. For many hospices, that mission extends to influencing public policy and practice.  Why should hospice agencies initiate or participate in research?

• To answer a question that has arisen from the field (i.e. do patients who receive therapeutic touch report lower pain levels than those who do not receive therapeutic touch?)
• To discover possible solutions to a problem or dilemma facing an organization (e.g. what factors are associated with long-term staff retention?)
• To foster a relationship with an academic or community partner (i.e. participation in a collaborative demonstration project regarding inpatient hospice units in a hospital setting)
• To stimulate innovative “out-of-the-box” thinking (i.e. focus group project on ways to revolutionize hospice care)
• To improve systems of care (i.e. what are the optimum interdisciplinary staff mix and staffing ratios?)
• To provide data to illustrate areas of opportunity/potential growth in an organization (i.e. needs assessment of community regarding end-of-life service needs)
• To provide data to educate staff about a particular issue (i.e. palliative chemotherapy and radiation usage among hospice patients)
• To position the organization as a leader in the field (i.e. national demonstration projects testing a service or service delivery method)
• To inform quality improvement projects (i.e. focus groups with current and bereaved caregivers regarding caregivers’ feedback about hospice services)
• To demonstrate/evaluate the effectiveness of current practice (i.e. to what degree are visits by hospice nurses, social workers, home health aides and chaplains meeting the self-identified needs of hospice patients and families?)
• To compare potential approaches to an issue or problem (i.e. compare retention rates of nurses in two groups – those who participated in an intensive residency program at the hospice agency versus those who did not).

Assessing Why You Want to Do Research
Before beginning a research project, hospice agencies may want to ask themselves the following questions:

• Has this research already been done somewhere else? If so, why do we want to do it again? What lessons can we learn from previous research on the topic? (A thorough literature review can help you begin to answer these questions.)
• Do we need to do research to answer the question we are asking, or do we think we already “know” the answer? If we think we already “know” the answer anecdotally, what is the benefit of researching the question in a formal manner? (While anecdotes are valuable, they may not be generalizable and therefore may only provide insight under certain conditions).
• If we are doing the research to influence public policy, what are the intended outcomes?
• Is there a way we could answer this question without doing a research project?
• Are we doing this research to position ourselves as a “leader” in the field? If so, why? What do we hope will come out of this beyond name recognition?
• Is research the best way to accomplish our goal if organizational change is the intended outcome?
• Why do we want to undertake this research project at this point in time? Is this a good use of resources for our organization right now?
• What type of research is needed to answer the question at hand?
• Does this research pass the “so what” test?
• Is this research something that is relevant for our mission, staff, patients and/or families?
• Is this research feasible in our setting?
• Is the research design sufficiently strong to be able to address the research question?
• Does this research sufficiently address issues of human research subject protection?

Types of Research
In conducting research, hospice agencies may utilize a variety of types of research.  In selecting a particular approach, researchers determine which method provides them with the needed information in the most efficacious manner. If they do not have someone with this expertise on staff, hospice agencies may want to consider consulting with a research expert in designing and implementing a research project if they are not familiar with the application of these methods.

• Descriptive Method: Descriptive research is used to describe a behavior, condition, or situation. Data collection is conducted using questionnaires, observations and/or interviews.  (Example: do attitudes about hospice differ between community residents over 65 and community residents ages 20-30?)
• Correlational Method: The purpose of correlational research is to determine the relationships between variables. (Example: is there a relationship between pain scores and opinions of hospice?)
• Causal-Comparative Method: This type of research is often used to determine whether there are cause-effect relationships in a behavior or a condition in groups of individuals. (Example: do high pains scores cause patients to have a more negative opinion of hospice?) However, it’s almost impossible to “prove” cause and effect. The example given might demonstrate an association, not true cause and effect.
• Experimental Method:  This research method is used to support or refute a hypothesis. Experimental research typically has control and experimental groups. (Example: hypothesis -- using aromatherapy in cancer patients has no effect on pain scores.) A control group is the group to which you compare an intervention, so it is typically a group receiving usual or “standard” care. An experimental group typically receives usual care plus an intervention, or an intervention in place of usual care.  When using the experimental method, it’s important to assign participants/subjects to intervention and control groups randomly. “Blinding” may be used to keep the researcher from knowing whether participants are in the treatment or control group.
• Historical Method: Historical research is used to predict or explain phenomena. The researcher analyzes documents and talks to “witnesses.” The researcher then formulates conclusions. (Example: What is the history of the Hospice Medicare Benefit?)
• Naturalistic Method (Qualitative): This type of research, often referred to qualitative research, seeks to answer “why” questions and to understand the “meaning” of an experience to the target group. The researcher strives to become part of the setting being studied and tries to write from the perspective of the participants. One limitation of this type of research is the fact that it may not produce results generalizable beyond the specific group studied. (Example: why do health care professionals come to work for hospice?)

The acquisition of knowledge is the mission of research, the transmission of knowledge is the mission of teaching and the application of knowledge is the mission of public service.  -- James A Perkins, President, Cornell

The trouble with research is that it tells you what people were thinking about yesterday, not tomorrow. It’s like driving a car using a rearview mirror.  -- Bernard Loomis, toy manufacturing executive