. 2019 Dec 3;11(1):21–33. doi: 10.1093/tbm/ibz178

Table 2.

Theory of change for Casarett evidence-based intervention (EBI)

Component of theory of change	Results
Primary causal pathway	• “Don’t lead the conversation by mentioning the “h” word [hospice], end the conversation by talking about hospice as a solution to self-identified needs”*: Reframing of the conversation from one about death and hospice to be about patient’s needs, goals, and preferences. For patients who “screened positive,” hospice was presented as a solution to the patient’s specific needs, goals, and preferences that they had expressed during the screening.
Secondary causal pathway	• “It allows for the potential to identify people who need hospice sooner…by…having these conversations about care goals, preferences, and needs without there being a precipitating event”*: Integrating the reframed conversation into usual care via standardized patient eligibility criteria for having the conversation and standardized timing of the conversation lessens the tendency to wait for a precipitating event (e.g., decline in clinical status and change in prognosis) to identify someone as needing hospice, improving timeliness of referrals to hospice.

Component of theory of change

Results

Primary causal pathway

• “Don’t lead the conversation by mentioning the “h” word [hospice], end the conversation by talking about hospice as a solution to self-identified needs”*: Reframing of the conversation from one about death and hospice to be about patient’s needs, goals, and preferences. For patients who “screened positive,” hospice was presented as a solution to the patient’s specific needs, goals, and preferences that they had expressed during the screening.

Secondary causal pathway

• “It allows for the potential to identify people who need hospice sooner…by…having these conversations about care goals, preferences, and needs without there being a precipitating event”*: Integrating the reframed conversation into usual care via standardized patient eligibility criteria for having the conversation and standardized timing of the conversation lessens the tendency to wait for a precipitating event (e.g., decline in clinical status and change in prognosis) to identify someone as needing hospice, improving timeliness of referrals to hospice.

*Quote from semistructured interviews.