Influence of patients' preferences and treatment site on cancer patients' end‐of‐life care

Wright, Alexi A.; Mack, Jennifer W.; Kritek, Patricia; Balboni, Tracy A.; Massaro, Anthony F.; Matulonis, Ursula A.; Block, Susan D.; Prigerson, Holly G.

doi:10.1002/cncr.25217

Cited by 116 publications

(110 citation statements)

References 44 publications

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“…Treatment preferences of patients with advanced cancer have been reported to be related to the aggressiveness of EOL care [35,36]. EOL conversations with physicians resulted in significantly lower health care costs in the final week of life and led to better quality of death [37].…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Hsu

Chang

et al. 2016

The Oncologist

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Introduction. Although palliative chemotherapy during end‐of‐life care is used for relief of symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive end‐of‐life care and less use of hospice service. This is a population‐based study of the association between palliative chemotherapy and aggressiveness of end‐of‐life care. Patients and Methods. Using the National Health Insurance Research Database of Taiwan, we identified 49,920 patients with metastatic cancer who underwent palliative chemotherapy from January 1, 2009, to December 31, 2011. Patients who received chemotherapy 2–6 months before death were included. Aggressiveness of end‐of‐life care was examined by previously reported indicators. Cardiopulmonary resuscitation and endotracheal tube intubation were included as indicators of aggressive end‐of‐life care. The association between palliative chemotherapy and hospice care was studied. Results. Palliative chemotherapy was associated with more aggressive treatment. After adjustment for patient age, sex, Charlson Comorbidity Index score, cancer group, primary physician's specialty, postdiagnosis survival, hospital characteristics, hospital caseload, urbanization, and geographic regions, more than one emergency room visit (p < .001), more than one intensive care unit admission (p < .001), and endotracheal intubation (p = .02) during end‐of‐life care were significantly more common in patients receiving palliative chemotherapy. Patients who did not receive palliative chemotherapy received more hospice care in the last 6 months of life (p < .001). Conclusion. Although the decision to initiate palliative chemotherapy was made several months before death, this study showed that palliative chemotherapy was associated with more aggressive end‐of‐life care, including more emergency room visits and intensive care unit admissions, and endotracheal intubation. The patients who received palliative chemotherapy received less hospice service toward the end of life. Implications for Practice: Palliative chemotherapy is used for patients with incurable cancer toward the end of life (EOL). Aggressiveness of EOL care and hospice care are related to the quality of life of these patients. This study of data from the Taiwanese National Health Insurance Research Database found that palliative chemotherapy led to more aggressive EOL care and less hospice care. There is a need to provide patients with terminal cancer access to care information that best meets their needs, especially those patients who receive palliative chemotherapy.

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Section: Comparison With Other Studiesmentioning

confidence: 99%

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Hsu

Chang

et al. 2016

The Oncologist

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“…Patients described their health status as terminally ill or not terminally ill. Caregivers of patients acknowledging terminal illness are less likely to experience post-loss PTSD. 6,14,37 Religiosity, religious support, and religious coping.…”

Section: Bereaved Caregiver Perception Of Quality Of Eol Care 851mentioning

confidence: 99%

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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“…[9][10][11]25,39 Although the majority of individuals with terminal illness prefer comfortfocused care at home, their care preferences are commonly not discussed or followed. 12,13,40,41 Hospice, by providing comprehensive patient-and family-centered care for seriously ill patients nearing the end of life, facilitates a transition to primarily home-based, holistic care focused on comfort and quality of life that is personalized to the individual patient's goals of care. Hospice additionally provides an immediate and always accessible on-call service for symptom management and acute changes in status that may preclude emergency medical services activation, emergency department evaluation, or rehospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…All of these care practices have been shown to reduce the intensity of care, lower hospitalization rates, and promote patient-centered care at the end of life. 9,12,[43][44][45][46] There are several limitations to this study. We could not directly measure the local systems of care, area resources, patient preferences, or practice patterns that may mediate the effects seen in this study.…”

Section: Discussionmentioning

confidence: 99%

“…8 Rehospitalizations in this patient population are associated with a diminished quality of life, and are often incongruent with the wishes of terminally ill patients, leading to a misalignment of patient expectation and care delivery. [9][10][11][12][13] Rehospitalizations are now a core quality measure for the Center for Medicare and Medicaid Services (CMS), with recently implemented financial penalties for hospitals with unacceptably high rates. Because rehospitalizations are at direct odds with the goals of hospice care, there is a growing interest in the potential role for hospice and palliative care in reducing rehospitalizations at the end of life.…”

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confidence: 99%

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Hospice Enrollment, Local Hospice Utilization Patterns, and Rehospitalization in Medicare Patients

Holden

Smith

Bartels

et al. 2015

Journal of Palliative Medicine

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Background: Rehospitalizations are prevalent and associated with decreased quality of life. Although hospice has been advocated to reduce rehospitalizations, it is not known how area-level hospice utilization patterns affect rehospitalization risk. Objectives: The study objective was to examine the association between hospice enrollment, local hospice utilization patterns, and 30-day rehospitalization in Medicare patients. Methods: With a retrospective cohort design, 1,997,506 hospitalizations were assessed between 2005 and 2009 from a 5% national sample of Medicare beneficiaries. Local hospice utilization was defined using tertiles representing the percentage of all deaths occurring in hospice within each Hospital Service Area (HSA). Cox proportional hazard models were used to assess the relationship between 30-day rehospitalization, hospice enrollment, and local hospice utilization, adjusting for patient sociodemographics, medical history, and hospital characteristics. Results: Rates of patients dying in hospice were 27% in the lowest hospice utilization tertile, 41% in the middle tertile, and 53% in the highest tertile. Patients enrolled in hospice had lower rates of 30-day rehospitalization than those not enrolled (2.2% versus 18.8%; adjusted hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.118-0.131). Patients residing in areas of low hospice utilization were at greater rehospitalization risk than those residing in areas of high utilization (19.1% versus 17.5%; HR, 1.05; 95% CI, 1.04-1.06), which persisted beyond that accounted for by individual hospice enrollment. Conclusions: Area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees.

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Influence of patients' preferences and treatment site on cancer patients' end‐of‐life care

Cited by 116 publications

References 44 publications

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

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

Hospice Enrollment, Local Hospice Utilization Patterns, and Rehospitalization in Medicare Patients

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