Survival of Medicare Patients after Enrollment in Hospice Programs

Christakis, Nicholas A.; Escarce, José J.

doi:10.1056/nejm199607183350306

Cited by 507 publications

(331 citation statements)

References 34 publications

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“…It is quite possible that inaccurate or overoptimistic assessment of prognosis led to longer fractionation schemes. Despite limitations of prognostication tools, and the accepted challenges of estimating survival, 23 hospice enrollment is generally considered a marker of limited life expectancy, 24,25 consistent with the findings in this study that found a median of 13 days from hospice enrollment through death.…”

Section: Survivalsupporting

confidence: 87%

Palliative Radiation Before Hospice: The Long and the Short of It

Yeung

Mitchell

Roeland

et al. 2014

Journal of Pain and Symptom Management

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Context. Randomized data support shorter radiotherapy courses for management of cancer-related symptoms in the palliative setting.Objectives. The purpose of this study was to evaluate the length of palliative radiotherapy before hospice enrollment among the elderly U.S. population, with a further focus on factors that influence the duration of radiation and the length of survival on hospice, including whether the duration of radiation was associated with length of survival on hospice.Methods. A total of 6982 patients with breast, prostate, lung, or colorectal cancer who received a course of radiotherapy within 30 days before hospice enrollment were identified within the Surveillance, Epidemiology, and End Results-Medicare linked database. The primary end points included the duration of palliative radiotherapy and the time from hospice enrollment through death (hospice duration). Multivariate linear regression and multivariate Cox models evaluated factors associated with the length of radiotherapy course and hospice duration.Results. The median length of palliative radiotherapy was 14 days, and the median hospice duration was 13 days. The course of palliative radiotherapy was longer than hospice duration in 48% of the patients. Breast and lung cancer were associated with longer courses of radiotherapy and shorter stays on hospice. Patients treated in freestanding radiation centers had longer courses of radiotherapy. For these groups, a longer radiotherapy course was not associated with longer hospice duration.Conclusion. This study found relatively long courses of radiotherapy before short lengths of survival on hospice. Future research is needed to identify barriers to shorter radiotherapy courses. J Pain Symptom Manage 2014;48:1070e1079.

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Section: Survivalsupporting

confidence: 87%

Palliative Radiation Before Hospice: The Long and the Short of It

Yeung

Mitchell

Roeland

et al. 2014

Journal of Pain and Symptom Management

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“…[15][16][17][18][19][20] The adequate utilization of hospice services requires timely referral of terminally ill patients to hospice programs. 21,22 Hospice care remains underutilized and patients are often referred to hospice very late in the course of their disease. [21][22][23][24][25][26] This may be because some terminal cancer patients want to continue cancer treatment options until they are too weak to tolerate them or because some patients think that hospice wards are places to go to die.…”

Section: Discussionmentioning

confidence: 99%

Impact of Combined Hospice Care on Terminal Cancer Patients

Loke

Rau

Huang

2011

Journal of Palliative Medicine

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Background: Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system. Patients and Methods: From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed. Results: A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% ( p < 0.0001), and awareness of disease prognosis from 46.05% to 57.69% ( p ¼ 0.0006). Combined hospice care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%). Conclusions: Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.

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“…It is identified clearly in the literature that clinicians have highly specific emotional, cognitive, and skill barriers to engaging in ACP (19). Emotional barriers often stem from their belief that such discussions would take away patients' hope, and physicians often explain their reticence to give a prognosis by virtue of the tendency of most patients not to ask for one (21,22). This study should help clinicians overcome some of the emotional barriers to ACP because these patients seemed more accepting of death as an inevitable outcome than their health care providers, and, contrary to popular belief, patients wanted to discuss end-of-life issues.…”

Section: Discussionmentioning

confidence: 99%

Facilitating Advance Care Planning for Patients with End-Stage Renal Disease

Davison

2006

Clinical Journal of the American Society of Nephrology

153

184

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Comprehensive care of patients with ESRD requires expertise in advance care planning (ACP), including attention to ethical, psychosocial, and spiritual issues related to starting, continuing, withholding, and stopping dialysis. However, there are no standards of care regarding when to initiate or how to facilitate ACP. The purpose of this study was to determine the perspectives of patients with ESRD of the salient elements of ACP discussions. An ethnographic, qualitative, in-depth interview study was conducted of outpatients of a university-affiliated nephrology program. Twenty-four patients with ESRD were purposively selected from the renal insufficiency, hemodialysis, and peritoneal dialysis clinics. Establishing patient "buy-in" by identifying perceived benefits of ACP along with acknowledging patients' sense of personal empowerment were critical both for the effective framing of facilitated ACP and for determining patients' ability to participate in facilitated ACP. Patients required more information and earlier initiation of ACP discussions. Information needed to focus more on the individual and how his or her illness and interventions would affect his or her life and relationships and what he or she values most. Empathetic listening also was viewed as an integral component of facilitated ACP. Physicians clearly were seen as having the responsibility for initiating and guiding ACP. The role of patients and family within ACP is complex and varies significantly between patients. For most, family was an integral component of ACP, and many relied extensively on family to make end-of-life decisions. These findings identify a precarious tension between patients' preferences in terms of facilitated ACP and current clinical practice.

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Survival of Medicare Patients after Enrollment in Hospice Programs

Cited by 507 publications

References 34 publications

Palliative Radiation Before Hospice: The Long and the Short of It

Palliative Radiation Before Hospice: The Long and the Short of It

Impact of Combined Hospice Care on Terminal Cancer Patients

Facilitating Advance Care Planning for Patients with End-Stage Renal Disease

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