Association between aggressive care and bereaved families’ evaluation of end‐of‐life care for veterans with non‐small cell lung cancer who died in Veterans Affairs facilities

Ersek, Mary; Miller, Susan C.; Thorpe, Joshua M.; Smith, Dawn; Levy, Cari; Gidwani, Risha; Faricy-Anderson, Katherine E.; Lorenz, Karl; Kinosian, Bruce; Mor, Vincent

doi:10.1002/cncr.30700

Cited by 64 publications

(75 citation statements)

References 33 publications

(90 reference statements)

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“…A t the end of life, hospitalized older adults often experience high-cost and low-quality care that does not improve survival, [1][2][3][4][5] quality of life, [5][6][7][8][9] or satisfaction, [10][11][12] and it is often incongruent with patients' values. [13][14][15][16] For example, despite most older adults preferring to remain at home, [13][14][15][16] 72% of elderly patients with advanced cancer experience aggressive medical treatments, such as mechanical ventilation and intensive care unit admissions, and 67% have two or more hospitalizations in the last month of life.…”

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confidence: 99%

“…[13][14][15][16] For example, despite most older adults preferring to remain at home, [13][14][15][16] 72% of elderly patients with advanced cancer experience aggressive medical treatments, such as mechanical ventilation and intensive care unit admissions, and 67% have two or more hospitalizations in the last month of life. 12 Action is needed to improve the care for patients who find themselves in hospitals near the end of life.…”

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confidence: 99%

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Quality of End‐of‐Life Care and Its Association with Nurse Practice Environments in U.S. Hospitals

Lasater

Sloane

McHugh

et al. 2018

J American Geriatrics Society

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Objectives The purpose of this study is twofold: (1) to describe the quality of end‐of‐life care in US hospitals from the perspective of hospital nurses; and (2) to evaluate the relationship between the nurse practice environment and end‐of‐life care quality. Design Cross‐sectional analysis of multiple linked secondary data sources. PARTICIPANTS and SETTING A total of 12,870 direct care registered nurses in 491 acute‐care hospitals. Measurements Measures of end‐of‐life care quality and nurse practice environment were derived from the 2016 RN4CAST‐US survey of nurses. Nurses reported on end‐of‐life care quality for patients for whom death within a year would not be surprising. Nurse practice environment was measured using the Practice Environment Scale of the Nursing Work Index, a National Quality Forum validated scale. Results Most nurses gave their hospitals an unfavorable evaluation of end‐of‐life care overall (58%) and said patients often experience painful procedures that were unlikely to change their outcome (53%). The best predictor of poor quality was the nurse practice environment. Nurses in the best environments were 55% less likely than nurses in poor environments to rate their hospital's overall end‐of‐life care quality unfavorably (odds ratio = 0.45; 95% confidence interval = 0.39–0.52; P < .001). Conclusion Quality of end‐of‐life care in US hospitals is imperfect and is significantly worse in hospitals with poor nurse practice environments than in hospitals with the best environments. This study reinforces the importance of nurses in providing high‐quality end‐of‐life care. J Am Geriatr Soc 67:302–308, 2019.

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confidence: 99%

mentioning

confidence: 99%

Quality of End‐of‐Life Care and Its Association with Nurse Practice Environments in U.S. Hospitals

Lasater

Sloane

McHugh

et al. 2018

J American Geriatrics Society

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“…Acute hospitalizations represent a large part of health care utilization and costs at the end of life (EOL) for patients with advanced cancer . Multiple hospitalizations and intensive care unit (ICU) utilization toward the EOL are considered burdensome by many older adults according to qualitative analyses involving families and other observational studies . Nonetheless, community‐dwelling patients with advanced cancer and a high symptom burden or functional decline are at high risk for these transitions, whereas receipt of hospice care decreases the likelihood of burdensome transitions …”

Section: Introductionmentioning

confidence: 99%

“…1,2 Multiple hospitalizations and intensive care unit (ICU) utilization toward the EOL are considered burdensome by many older adults according to qualitative analyses involving families and other observational studies. [3][4][5][6] Nonetheless, community-dwelling patients with advanced cancer and a high symptom burden or functional decline are at high risk for these transitions, whereas receipt of hospice care decreases the likelihood of burdensome transitions. 6 Nursing home (NH) residents with cancer are a growing and particularly vulnerable group of older adults.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6] Nonetheless, community-dwelling patients with advanced cancer and a high symptom burden or functional decline are at high risk for these transitions, whereas receipt of hospice care decreases the likelihood of burdensome transitions. 6 Nursing home (NH) residents with cancer are a growing and particularly vulnerable group of older adults. 7 Although this population is not well studied, some studies point to multiple comorbidities, a high symptom burden, and high rates of hospitalization among NH residents with cancer.…”

Section: Introductionmentioning

confidence: 99%

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Potentially burdensome end‐of‐life transitions among nursing home residents with poor‐prognosis cancer

Lage

DuMontier

Lee

et al. 2019

Cancer

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Background This study examined factors associated with potentially burdensome end‐of‐life (EOL) transitions between care settings among older adults with advanced cancer in nursing homes (NHs). Methods A retrospective analysis of deceased older NH residents with poor‐prognosis solid tumors was conducted with Medicare claims and the Minimum Data Set. A potentially burdensome transition was defined as 2 or more hospitalizations or an intensive care unit admission in the last 90 days of life. Results Among 34,670 subjects, many had moderate to severe cognitive impairment (53.8%), full dependence in activities of daily living (ADLs; 66.5%), and comorbidities such as congestive heart failure (CHF; 29.3%) and chronic obstructive pulmonary disease (34.1%). Only 56.3% of the patients used hospice at any time in the 90 days before death; 36.0% of the patients experienced a potentially burdensome EOL transition, and this was higher among patients who did not receive hospice (45.4% vs 28.7%; P < .01). In multivariable analyses, full dependence in ADLs (odds ratio [OR], 1.70; P < .01), CHF (OR, 1.48; P < .01), and chronic obstructive pulmonary disease (OR, 1.28; P < .01) were associated with a higher risk of burdensome EOL transitions. Those with do‐not‐resuscitate directives (OR, 0.60; P < .01) and impaired cognition (OR, 0.89; P < .01) had lower odds of burdensome EOL transitions. Conclusions NH residents with advanced cancer have substantial comorbidities and functional impairment, yet more than a third experience potentially burdensome EOL transitions. These findings help to identify a population at risk for poor EOL outcomes in order to target interventions, and they point to the importance of advanced care planning in this population.

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Association of Family Ratings of Quality of End-of-Life Care With Stopping Dialysis Treatment and Receipt of Hospice Services

et al. 2019

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Association between aggressive care and bereaved families’ evaluation of end‐of‐life care for veterans with non‐small cell lung cancer who died in Veterans Affairs facilities

Cited by 64 publications

References 33 publications

Quality of End‐of‐Life Care and Its Association with Nurse Practice Environments in U.S. Hospitals

Quality of End‐of‐Life Care and Its Association with Nurse Practice Environments in U.S. Hospitals

Potentially burdensome end‐of‐life transitions among nursing home residents with poor‐prognosis cancer

Association of Family Ratings of Quality of End-of-Life Care With Stopping Dialysis Treatment and Receipt of Hospice Services

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