Interventions to Improve Hospice and Palliative Care Referral: A Systematic Review

Kirolos, Irene; Tamariz, Leonardo; Schultz, Elizabeth; Diaz, Yvonne; Wood, Barbara; Palacio, Ana

doi:10.1089/jpm.2013.0503

Cited by 21 publications

(17 citation statements)

References 34 publications

(92 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Healthcare providers need to better identify noncancer patients who would qualify for and benefit from hospice. This requires improved prognostication, better patient‐provider communication (eg, goals of care conversations), engaging attending physicians, greater adoption of open access policies, and improving hospice outreach . Research is also needed on barriers to hospice use among noncancer patient populations and how to overcome them.…”

Section: Discussionmentioning

confidence: 99%

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Cagle

Lee

Ornstein

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

OBJECTIVES Reliable national estimates of hospice use and underuse are needed. Additionally, drivers of hospice use in the United States are poorly understood, especially among noncancer populations. Thus the objectives of this study were to (1) provide reliable estimates of hospice use among adults in the United States; and (2) identify factors predicting use among decedents and within subsamples of cancer and noncancer deaths. DESIGN We conducted a prospective cohort study using the Health and Retirement Study survey. Excluding sudden deaths, we used data from the 2012 survey wave to predict hospice use in general, and then separately for cancer and non‐cancer deaths. SETTING Study data were provided by a population‐based sample of older adults from the U.S. PARTICIPANTS We constructed a sample of 1,209 participants who died between the 2012 and 2014 survey waves. MEASUREMENTS Hospice utilization was reported by proxy. Exposure variables included demographics, functionality (activities of daily living [ADLs]), health, depression, dementia, advance directives, nursing home residency, and cause of death. RESULTS Hospice utilization rate was 52.4% for the sample with 70.8% for cancer deaths and 45.4% for noncancer deaths. Fully adjusted model results showed being older (odds ratio [OR] = 1.54), less healthy (OR = .79), having dementia (OR = 1.52), and having cancer (OR = 5.47) were linked to greater odds of receiving hospice. Among cancer deaths, being older (OR = 1.64) and female (OR = 2.54) were the only predictors of hospice use. Among noncancer deaths, increased age (OR = 1.58), more education (OR = 1.56), being widowed (OR = 1.55), needing help with ADLs (OR = 1.13), and poor health (OR = .77) were associated with hospice utilization. CONCLUSION Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings. J Am Geriatr Soc 68:783–793, 2020

show abstract

Section: Discussionmentioning

confidence: 99%

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Cagle

Lee

Ornstein

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…This is also reported by many researchers worldwide [ 30 , 31 , 34 ] and seems to be one of the main barriers to PC when treating CHF patients. To overcome this specific barrier several recommendations were made: e.g., interdisciplinary and multi-professional education targeting this theme ( PC) [ 33 , 55 – 57 ], establishing multi-professional teams [ 58 , 59 ], key workers [ 31 ], along with setting up solid pathways of care between cardiology and PC teams [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals

Ziehm

Farin

Schäfer

et al. 2016

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundCompared to patients with cancer, heart failure patients are seldom candidates for palliative care. Numerous studies have investigated reasons why heart failure patients do not receive palliative care; however, none of these studies have ever evaluated the situation in the German health care setting. This study aims to identify German healthcare providers’ (HCP) perception of barriers and facilitators to palliative care of patients with chronic heart failure.MethodsWe conducted an online-survey with 315 nurses and physicians of different medical disciplines.ResultsEven though heart failure patients’ need of palliative care and its advantages has been recognized, HCP see potential for development and improvement. A lack of knowledge about the content and measures of palliative care, poor communication and unclear responsibilities between medical disciplines, difficulties to determine the right time to initiate palliative care, and the feeling not to be prepared to discuss end-of-life issues with the patient has been identified as barriers. Further, HCP believe that patients and relatives do not possess adequate knowledge about the disease and its progression and are therefore unprepared in asking questions regarding palliative care. They rather tend to demand everything possible to be done in order prolong life, and are reluctant to accept that life is limited. Overall, HCP perceive that dying is a taboo subject within our society placing palliative care on the same level as assisted dying. In addition, results indicate that HCP have an inappropriate notion of ideal medicine fearing to lose patient and are worried about the appropriateness of PC remuneration.ConclusionsIn order to overcome the described barriers, HCP, patients, and relatives need to be educated in palliative care. Information and education encompassing the aim, content and measures of palliative care needs to be provided for all parties in order to optimize patient care, to foster communication between healthcare professionals, patients, and relatives, and to overcome perceived barriers.Trial registrationDRKS00007119Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1609-x) contains supplementary material, which is available to authorized users.

show abstract

“…In addition, aggressive care is an important driver of health care costs [3], though it does not always yield benefits relative to cure or extension of life [4]. Conversely, palliative and hospice care provide a venue for pain management and symptom relief, as well as emotional and spiritual support, which may be beneficial to the patient and his/her family [5–7]. …”

Section: Introductionmentioning

confidence: 99%

Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer

Koroukian

Schiltz

Warner

et al. 2017

Journal of Geriatric Oncology

View full text Add to dashboard Cite

Objective Most prior studies on aggressive end-of-life care in older patients with cancer have accounted for social determinants of health (e.g., race, income, and education), but rarely for multimoribidity (MM). In this study, we examine the association between end-of-life care and each of the social determinants of health and MM, hypothesizing that higher MM is associated with less aggressive care. Methods From the linked 1991–2008 Health and Retirement Study, Medicare data, and the National Death Index, we identified fee-for-service patients age ≥66 years who died from cancer (n = 835). MM was defined as the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. Aggressive care was based on claims-derived measures of receipt of cancer-directed treatment in the last two weeks of life; admission to the hospital and/or emergency department (ED) within the last month; and in-hospital death. We also identified patients enrolled in hospice. In multivariable logistic regression models, we analyzed the associations of interest, adjusting for potential confounders. Results While 61.2% of the patients enrolled in hospice, 24.6% underwent cancer-directed treatment; 55.1% were admitted to the hospital and/or ED; and 21.7% died in the hospital. We observed a U-shaped distribution between income and in-hospital death. Chronic conditions and geriatric syndromes were associated with some outcomes, but not with others. Conclusions To improve quality end-of-life care and curtail costs incurred by dying patients, relevant interventions need to account for social determinants of health and MM in a nuanced fashion.

show abstract

Interventions to Improve Hospice and Palliative Care Referral: A Systematic Review

Abstract: Interventions of different levels of complexity can improve the use of hospice services among subjects with high mortality risk. An approach that allows the medical team to assess patients' treatment goals and that engages the treating physician seems to be the most successful one.

Cited by 21 publications

References 34 publications

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals

Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer

Contact Info

Product

Resources

About