Depression Among Surviving Caregivers: Does Length of Hospice Enrollment Matter?

Bradley, Elizabeth H.; Prigerson, Holly G.; Carlson, Melissa; Cherlin, Emily; Johnson-Hürzeler, Rosemary; Kasl, Stanislav V.

doi:10.1176/appi.ajp.161.12.2257

Cited by 117 publications

(105 citation statements)

References 27 publications

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“…6,[53][54][55] These findings are particularly relevant to health care professionals working in acute care settings. Recent U.S. data highlight a decrease in overall hospital deaths and an increase in hospice enrollment in the last month of life, tempered by an increase in ICU admission in the final month of life and hospice admission in the final three days of life.…”

Section: Discussionmentioning

confidence: 90%

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

Higgins

Garrido

Prigerson

2015

Journal of Palliative Medicine

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Background: Cancer caregivers are key stakeholders in the final weeks of life and in bereavement. Research has highlighted end-of-life (EOL) factors important to caregivers, as well as factors contributing to caregiver mental health and bereavement outcomes. There has been limited data on factors predicting caregiver perceptions of quality of EOL care. Objective: This study's purpose was to identify modifiable predictors of caregivers' Caregiver Evaluation of Quality of End of Life Care (CEQUEL) scores, with the broader aim of informing clinical interventions to improve caregiver impressions of care and subsequent bereavement adjustment. Methods: Study data came from Coping with Cancer I (CwC1). CwC1 investigators interviewed advanced cancer patients and caregivers prior to the patient's death (Wave 1) and reinterviewed caregivers following the death (Wave 2) (N = 275 dyads). The authors identified potential Wave 1 predictors of CEQUEL scores and performed a series of linear regression analyses to identify a parsimonious predictive model using corrected Akaike's Information Criterion (AICc) values. Results: In adjusted analyses, caregivers rated quality of care as poorer when patients died in a hospital (B = -1.40, SE = 0.40, p = 0.001) (B, unstandardized regression coefficient; SE, standard error) or had less than one week of inpatient hospice care (B = -1.98, SE = -0.70, p = 0.006). Whole-person physician care and caregiver religiosity were associated with perceived higher quality of care in unadjusted, but not adjusted, analyses. Conclusions: Findings suggest that place of death and hospice length of stay best predict bereaved caregiver evaluations of quality of EOL care. These findings equip health care providers with modifiable targets to improve caregivers' experience of EOL care and subsequent bereavement.

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Section: Discussionmentioning

confidence: 90%

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

Higgins

Garrido

Prigerson

2015

Journal of Palliative Medicine

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“…There has been both a declining median length of service (LOS) 15 and an increase in short LOS, both for # 3 days 18 and for # 7 days. 19 This is a concerning trend, given that these short LOSs are associated with poorer outcomes, including higher rates of major depression, 20,21 poorer pain management, 22 and worse helpfulness ratings. 23 These findings point to a need for providers to refer patients to hospice earlier in disease progression and care.…”

Section: Introductionmentioning

confidence: 99%

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Wang

Knight

Evans

et al. 2017

JOP

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Purpose: The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. Methods: We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. Results: Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P < .01). In addition, there was dramatic variation in median LOS by individual physician (range, 4 to 88 days for physicians with five or more patients), indicating differences in hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. Conclusion: Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.

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“…6 Hospice also has beneficial effects for families and caregivers by improving family functioning, 7 bereavement adjustment 7-9 satisfaction with care, 8,[10][11][12] and mental health. 3,[13][14][15] Despite the potential benefits of hospice enrollment for individuals and families, the majority of patients with serious illness still do not use hospice. 1 Furthermore, most individuals who use hospice are admitted very close to the end of life.…”

Section: Introductionmentioning

confidence: 99%

Spousal Characteristics and Older Adults' Hospice Use: Understanding Disparities in End-of-Life Care

Ornstein

Aldridge

Mair

et al. 2016

Journal of Palliative Medicine

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Background: Hospice use has been shown to benefit quality of life for patients with terminal illness and their families, with further evidence of cost savings for Medicare and other payers. While disparities in hospice use by patient diagnosis, race, and region are well documented and attention to the role of family members in endof-life decision-making is increasing, the influence of spousal characteristics on the decision to use hospice is unknown. Objectives: To determine the association between spousal characteristics and hospice use. Design: We used data from the Health and Retirement Study (HRS), a prospective cohort study, linked to the Dartmouth Atlas of Health Care and Medicare claims. Setting: National study of 1567 decedents who were married or partnered at the time of death (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011). Measures: Hospice use at least 1 day in the last year of life as measured via Medicare claims data. Spousal factors (e.g., education and health status) measured via survey. Results: In multivariate models controlling for patient factors and regional variation, spouses with lower educational attainment than their deceased spouse had decreased likelihood of hospice use (odds ratio [OR] = 0.58; 95% confidence interval [CI] = 0.40-0.82). Health of the spouse was not significantly associated with likelihood of decedent hospice use in adjusted models. Implications: Although the health of the surviving spouse was not associated with hospice use, their educational level was a predictor of hospice use. Spousal and family characteristics, including educational attainment, should be examined further in relation to disparities in hospice use. Efforts to increase access to high-quality end-of-life care for individuals with serious illness must also address the needs and concerns of caregivers and family.

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Depression Among Surviving Caregivers: Does Length of Hospice Enrollment Matter?

Cited by 117 publications

References 27 publications

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Spousal Characteristics and Older Adults' Hospice Use: Understanding Disparities in End-of-Life Care

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