Hospice Admissions for Cancer in the Final Days of Life: Independent Predictors and Implications for Quality Measures

O’Connor, Nina; Hu, Rong; Harris, Pamela; Ache, Kevin A.; Casarett, David

doi:10.1200/jco.2014.55.8817

Cited by 64 publications

(53 citation statements)

References 28 publications

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“…8 About a decade later, a study of over 64,000 patients demonstrated similar results: patients with hematologic cancers had 52% higher odds of a hospice length of stay ≤ 3 days compared to those with solid malignancies. 9 …”

Section: Introductionmentioning

confidence: 99%

Why are patients with blood cancers more likely to die without hospice?

Odejide

Cronin

Earle

et al. 2017

Cancer

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Background Although patients with blood cancers have significantly lower rates of hospice use compared to those with solid malignancies, data explaining this gap in end-of-life care are sparse. Methods In 2015, we conducted a mailed survey of a randomly selected sample of hematologic oncologists in the United States to characterize their perspectives regarding the utility and adequacy of hospice for blood cancer patients, as well as factors that might impact referral patterns. Simultaneous provision of care for patients with solid malignancies was permitted. Results We received 349 surveys (response rate=57.3%). The majority of respondents (68.1%) strongly agreed that hospice care is “helpful” for patients with hematologic cancers; those with practices including greater numbers of solid tumor patients (at least 25%) were more likely to strongly agree (OR=2.10, 95% CI 1.26, 3.52). Despite high levels of support for hospice in general, 46.0% felt that home hospice is “inadequate” for their patients’ needs (as compared to inpatient hospice with round-the-clock care). While over half of respondents reported they would be more likely to refer to hospice if red cell and/or platelet transfusions were available, those who considered home hospice inadequate were even more likely to report they would (67.3% vs. 55.3%, p=0.03 for red cells and 52.9% vs. 39.7%, p=0.02 for platelets). Conclusions These data suggest that although hematologic oncologists value hospice, concerns about adequacy of services for blood cancer patients limit hospice referrals. To increase hospice enrollment for blood cancer patients, interventions tailoring hospice services to their specific needs are warranted.

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Section: Introductionmentioning

confidence: 99%

Why are patients with blood cancers more likely to die without hospice?

Odejide

Cronin

Earle

et al. 2017

Cancer

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“…Short hospice stays (£3 days) have increased to 28.4% of all hospice stays 1 and 14.3% of patients with cancer who enroll in hospice do so in the last 3 days of life. 16 While lack of hospice utilization or underutilization may be attributable to documented differences in patient characteristics (e.g., diagnosis, race, ethnicity, and income [17][18][19][20][21][22], and geographic region (e.g., hospice resources available, variation in services hospices provide [23][24][25] ), the decision-making process regarding hospice enrollment is often based within the family unit. 22,[26][27][28][29] While the family has a crucial role in determining hospice utilization, little is known about how family characteristics are associated with the decision to use hospice.…”

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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“…The study population included patients of all ages (36% were , 65 years of age) with a wide range of insurance types, which has previously been associated with hospice lengths of stay. 32 It also included patients who recurred with advanced cancer and may have different experiences near death than patients with advanced cancer at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Family Perspectives on Hospice Care Experiences of Patients with Cancer

Kumar

Wright

Hatfield

et al. 2017

JCO

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To determine whether hospice use by patients with cancer is associated with their families' perceptions of patients' symptoms, goal attainment, and quality of end-of-life (EOL) care. MethodsWe interviewed 2,307 families of deceased patients with advanced lung or colorectal cancer who were enrolled in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) and died by 2011. We used propensity-score matching to compare family-reported outcomes for patients who did and did not receive hospice care, including the presence and relief of common symptoms (ie, pain, dyspnea), concordance with patients' wishes for EOL care and place of death, and quality of EOL care. We also examined associations between hospice length of stay and these outcomes among hospice enrollees. ResultsIn a propensity-score-matched sample of 1,970 individuals, families of patients enrolled in hospice reported more pain in their patient compared with those not enrolled in hospice. However, families of patients enrolled in hospice more often reported that patients received "just the right amount" of pain medicine (80% v 73%; adjusted difference, 7 percentage points; 95% confidence interval [CI], 1 to 12 percentage points) and help with dyspnea (78% v 70%; adjusted difference, 8 percentage points; 95% CI, 2 to 13 percentage points). Families of patients enrolled in hospice also more often reported that patients' EOL wishes were followed (80% v 74%; adjusted difference, 6 percentage points; 95% CI, 2 to 11 percentage points) and "excellent" quality EOL care (57% v 42%; adjusted difference, 15 percentage points; 95% CI, 11 to 20). Families of patients who received . 30 days of hospice care reported the highest quality EOL outcomes. ConclusionHospice care is associated with better symptom relief, patient-goal attainment, and quality of EOL care. Encouraging earlier and increased hospice enrollment may improve EOL experiences for patients with cancer and their families.

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Hospice Admissions for Cancer in the Final Days of Life: Independent Predictors and Implications for Quality Measures

Cited by 64 publications

References 28 publications

Why are patients with blood cancers more likely to die without hospice?

Why are patients with blood cancers more likely to die without hospice?

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

Family Perspectives on Hospice Care Experiences of Patients with Cancer

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