A Critical Discourse Analysis of the Language of Hospice Enrollment

Background Despite the demonstrated benefits of hospice care, enrollment among Medicare beneficiaries continues to decline. Previous research has identified multiple barriers, such as a lack of knowledge, a pervasive mistrust of the healthcare system, and a lack of diversity among hospice care providers and sociocultural structures. However, a study on the discourse of hospice enrollment has yet to be done. A thorough analysis of the discourse in hospice enrollment could reveal how social structures and power dynamics contribute to enrollment barriers. Objective To examine how language and power dynamics shape hospice enrollment decisions among patients, caregivers, and healthcare professionals using a critical discourse analysis framework. Methods A qualitative critical discourse analysis using Fairclough’s three-dimensional framework was conducted in combination with a multiple case study design that included 4 participant groups: patients, their primary family caregivers, hospice registered nurses, and medical directors. Findings Three dominant discourses were revealed: decision dynamics, help, and beliefs and believe. Conclusion This study highlights the significant impact of societal constructs, power relations, and personal convictions on hospice enrollment discourse. The findings emphasize the need for patient-centered approaches to hospice enrollment that recognize and engage familial dynamics, societal norms, and personal autonomy.