HOPE Guidance Manual v1.02, Item F3000

Timepoint(s) Item Completed

Admission (ADM)

Item-Specific Instructions

• Item completion should be based on what is included in the clinical record.

• Review the clinical record for information regarding discussion of patient preference regarding

spiritual/existential concerns.

• Consider care processes and discussions documented in the clinical record that took place during pre-admission or educational visits, as well as those during the admission assessment.

• Review all response choices before making a selection.

• Use the date on which the discussion first occurred.

A. Was the patient and/or caregiver asked about spiritual/existential concerns?

• Code 0, No, if there is no documentation that the hospice discussed (or attempted to discuss)

spiritual/existential concerns with the patient and/or caregiver(s). Skip to Item I0010, Principal

Diagnosis.

o This applies to situations where there is no documentation that a discussion occurred or was

attempted with the patient and/or caregiver (e.g., the patient was unable to discuss and/or the

caregiver was unavailable).

• Code 1, Yes, and discussion occurred, if there is documentation that the hospice discussed

spiritual/existential concerns with the patient and/or caregiver(s).

o This applies to situations where there is documentation that the hospice brought up the topic of

spiritual/existential concerns and engaged or had a conversation with the patient and caregiver. The

conversation does not have to result in the initiation of intervention(s) to address spiritual/existential

concerns.

• Code 2, Yes, but patient and/or caregiver refused to discuss, if there is documentation that

the hospice asked about spiritual/existential concerns, but the patient and/or caregiver(s) refused to

discuss or were unable to discuss. The hospice was not successful in engaging the patient and/or

caregiver in a discussion.

o This applies to situations where there is documentation that the hospice attempted to have a

conversation with the patient and caregiver, but both the patient and caregiver explicitly refused to

discuss the topic with the hospice (e.g., “I don’t want to talk about this” or “I’m only going to talk to

my priest about this”) or the patient was unable to discuss because of their clinical status and the

caregiver explicitly refused to discuss.

B. Date the patient and/or caregiver was first asked about spiritual/existential concerns.

• Enter the date the hospice discussed (or attempted to discuss) spiritual/existential concerns.

• Multiple discussions regarding spiritual/existential concerns may be documented in the clinical record.

• Completion of this item is based on the first dated discussion about spiritual/existential concerns that

appear in the clinical record.

Coding Tips

• For the purposes of completing this item, the “caregiver” does not have to be the legally authorized

representative.

• There is no comprehensive list of spiritual/existential concerns.

o Examples of a discussion regarding spiritual/existential concerns might include but are not limited to

asking the patient/caregiver about the need for spiritual or religious support, having a discussion

about a higher power related to illness, or offering a spiritual resource (such as a chaplain).

• Documentation in the clinical record indicating that a member of the hospice staff or IDG attempted to

discuss spiritual/existential concerns is sufficient to select either of the following for F3000A:

o “1, Yes, and discussion occurred.”

o “2, Yes, but the patient and/or caregiver refused to discuss.”

• Brief statements or data in the clinical record denoting a patient’s religious affiliation, or that denotes a

spiritual visit was offered without documentation of a discussion is not sufficient to code “Yes” for

F3000A.

• While these conversations are best held face-to-face, phone conversations with patients/families about

spiritual/existential issues can be used to answer yes to F3000 as long as the clinical documentation

supports that a discussion was had with the patient and/or caregiver.

• A discussion with the patient and/or caregiver(s) about spiritual/existential concerns can be initiated by

any member of the hospice staff or IDG.

Examples

1. Social worker assessment dated 08-01-2025 shows, “Patient’s spouse in a great deal of spiritual distress

and would like to speak with a chaplain. Referral made.”

Coding: F3000A: Was the patient and/or caregiver asked about spiritual/existential concerns? would be

coded 1, Yes, and discussion occurred. F3000B: Date the patient and/or caregiver was first asked about

spiritual/existential concerns. Enter “08-01-2025.”

Rationale: The completed assessment is strong evidence that the hospice engaged the patient and/or

caregiver in a discussion regarding spiritual/existential concerns. Even though the clinical record does

not contain documentation of a visit by the chaplain, code “1, Yes, and discussion occurred” because the

intent of F3000 is to capture the initiation of a discussion about spiritual/existential concerns.

2. Patient’s initial assessment shows, “patient identifies their religious affiliation as Baptist.”

Coding: F3000A: Was the patient and/or caregiver asked about spiritual/existential concerns? would be

coded “0, No” and skip to Item I0010, Principal Diagnosis.

Rationale: The intent of F3000 is to capture initiation of a discussion (or attempted discussion) about

spiritual/existential concerns. Clinical record documentation showing only the patient’s religious

affiliation is not sufficient evidence that the hospice had (or attempted to have) a discussion regarding

spiritual/existential concerns with the patient and/or caregiver.