Late Referral to Hospice and Bereaved Family Member Perception of Quality of End-of-Life Care

Schockett, Erica; Teno, Joan M.; Miller, Susan C.; Stuart, Brad

doi:10.1016/j.jpainsymman.2005.04.013

Cited by 113 publications

(99 citation statements)

References 38 publications

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“…Similar conclusions have been made in a number of studies addressing barriers to palliative care access [13][14][15] , and programs such as Living Lessons have been set up to increase public awareness of palliative care 16 . Schockett et al found that late referral to end-of-life care, such as to outpatient hospice in the United States, was positively associated with lower patient and family satisfaction with care 14 . This preliminary indication of reduced benefit, which may also apply to palliative care in Canada, supports the preparation programs mentioned earlier.…”

Section: Discussionsupporting

confidence: 65%

Demographic Profile and Utilization Statistics of a Canadian Inpatient Palliative Care Unit within a Tertiary Care Setting

Napolskikh¹,

Selby

Bennett

et al. 2009

Current Oncology

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Background: Canadian data describing inpatient palliative care unit (PCU) utilization are scarce. In the present study, we performed a quality assessment of a 24-bed short-term PCU with a 3-months-or-less life expectancy policy in a tertiary care setting. Methods: Using a retrospective chart review, we explored wait time (WT) for admission (May 2005 to April 2006), length of stay [LOS (February 2005 to January 2006)], and patient demographics. Results: The WT data showed 508 referrals, with 242 resulting in admissions (92% malignant diagnoses) and 266 not (82% malignant). The most common malignancies in both groups were gastrointestinal, lung, and genitourinary. Median WT for admitted patients was 6 days, varying with referral source, such as the same hospital, home, or another hospital (6, 4, and 8.5 days respectively). Most admissions (93%) occurred in 21 or fewer days. Patient death (52%), admission to another PCU (25%), and declined offer (10%) were common reasons for no admission. Median LOS for 219 admitted patients was 19 days (range: 0–249 days). Most patients (94%) died in the PCU; a minority were discharged. Conclusions: Many patients requiring PCU services are admitted within a few days of referral, especially patients with the least available support: those at home. However, half of the non-admitted patients die while waiting—a potential area for improvement. The LOS for admitted patients complied with the 3-month “expected lifespan” PCU policy. Results are significant, because ensuring quality of life for palliative care patients includes timely PCU access and sufficient LOS to address end-of-life needs.

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Section: Discussionsupporting

confidence: 65%

Demographic Profile and Utilization Statistics of a Canadian Inpatient Palliative Care Unit within a Tertiary Care Setting

Napolskikh¹,

Selby

Bennett

et al. 2009

Current Oncology

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“…17 Late referrals to hospice correlate with lower overall family satisfaction, lower satisfaction with hospice services, more unmet needs, lack of awareness about what to expect at time of death, lower confidence in participating in patient care at home, and more concerns about coordination of care. 18 In half of all cases of late referral, family members reported that physicians were a barrier to earlier hospice referral. 19 It can be difficult to determine when to transition from nonhospice palliative care to hospice, and this should be a group decision made among patient, family members, and healthcare providers.…”

Section: Relationship Of Nonhospice Palliative Care To Hospice Palliamentioning

confidence: 99%

Palliative Care in the Treatment of Advanced Heart Failure

et al. 2009

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H eart failure is epidemic in developed countries and is expanding rapidly worldwide. Roughly 5% of patients with heart failure have end-stage disease that is refractory to medical therapy (stage D heart failure). 1 Palliative care consultation relieves symptoms, improves patient satisfaction, and decreases the costs of care for these patients. Despite this, only a small fraction of end-stage heart failure patients receive palliative care consultation. In recognition of this, palliative/hospice care referral was recommended for endstage heart failure (Level of Evidence 1A) in the most recent American College of Cardiology/American Heart Association heart failure guidelines. 2 To identify evidence-based studies of palliative care in heart failure, we searched the Medline database for literature with the medical subject headings "heart failure" and "palliative care," "supportive care," or "symptom management" and found 394 results. We identified 92 systematic reviews, 44 of which were English-language systematic reviews published within the past 5 years.

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“…3,4 In addition, earlier hospice enrollment may provide added benefits of increased family satisfaction and greater cost savings. 5,6 Despite the potential benefits of early hospice enrollment, many patients with cancer are admitted to hospice close to the end of life. In 2012, for instance, the median length of stay in hospice in the United States was only 18.7 days.…”

Section: Introductionmentioning

confidence: 99%

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

O’Connor

Harris

et al. 2014

JCO

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Purpose To define patient characteristics associated with hospice enrollment in the last 3 days of life, and to describe adjusted proportions of patients with late referrals among patient subgroups that could be considered patient-mix adjustment variables for this quality measure. Methods Electronic health record–based retrospective cohort study of patients with cancer admitted to 12 hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. Results Of 64,264 patients admitted to hospice with cancer, 10,460 (16.3%) had a length of stay ≤ 3 days. There was significant variation among hospices (range, 11.4% to 24.5%). In multivariable analysis, among patients referred to hospice, patients who were admitted in the last 3 days of life were more likely to have a hematologic malignancy, were more likely to be male and married, and were younger (age < 65 years). Patients with Medicaid or self-insurance were less likely to be admitted to hospice within 3 days of death. Conclusion Quality measures of hospice lengths of stay should include patient-mix adjustments for type of cancer and site of care. Patients with hematologic malignancies are at especially increased risk for late admission to hospice.

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Late Referral to Hospice and Bereaved Family Member Perception of Quality of End-of-Life Care

Cited by 113 publications

References 38 publications

Demographic Profile and Utilization Statistics of a Canadian Inpatient Palliative Care Unit within a Tertiary Care Setting

Demographic Profile and Utilization Statistics of a Canadian Inpatient Palliative Care Unit within a Tertiary Care Setting

Palliative Care in the Treatment of Advanced Heart Failure

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

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