Timely Referral to Hospice Care for Oncology Patients: A Retrospective Review

Abstract

Hospice care is medical care provided to terminally ill patients with a life expectancy of 6 months or less. Hospice services include symptom control, pain management, palliative care, and other supportive services such as providing for home equipment or oxygen; however, it does not provide for life-prolonging therapies such as chemotherapy. Although oncologic benchmarks suggest patients should be enrolled in hospice 3 months prior to death, studies show that most hospice referrals are being made too late. These shorter stays in hospice result in increased cost of care especially at the end of life with most patients dying on aggressive treatments in the hospital. Thus, identifying barriers to hospice placement is critical in improving the referral process and enhancing the quality of end-of-life care. This retrospective study collected data on 418 oncologic patients who passed in 2015 and categorized patients based on hospice status at the time of death. Our study found that the demographics between hospice and nonhospice patients were not significantly different. Hospice patients spent a median of 10 days in hospice and 71% (n ¼ 161) of patients were in hospice 30 days or less. Additionally, 56% of patients were in hospice 10 days or less. Increased education for patients and health-care providers along with better utilization of palliative care services and incorporating a nurse navigator to help with transitioning patients to hospice would improve earlier referral to hospice care and enhance patients' quality of life.

What Makes Palliative Care Needs “Complex”?: A Multisite Sequential Explanatory Mixed Methods Study of Patients Referred to Specialist Palliative Care

“…28,29 However referral for SPC including hospice care tends to occur in the late stage of advanced illness. 30,31 Staff recognised that complex needs could occur earlier, or could be prevented with earlier intervention, though the capacity implications of offering services at an earlier stage was a concern. Research shows that quality of life of people with a terminal illness oscillates over time, and for some distress peaks on diagnosis or recurrence.…”

Off-label drug use in palliative care – a narrative review

“…Tymczasem opieka paliatywna skupia się głównie na pacjentach z wieloma schorzeniami, którzy są u kresu życia [6]. Stosowanie w tym przypadku z po wodzeniem leków (4,5-35% preparatów) [7] skupia się na dobrze poznanych mechanizmach działania znajdujących się w nich substancji aktywnych oraz sprawdzonych sposobach ich podawania.…”

Diabetes mellitus in the last weeks of life – case study and current literature review

“…Częstość występowania zaburzeń gospodarki węglowodanowej u osób starszych sięga 40%. Opieką paliatywną i hospicyjną objęci są pacjenci w różnym wieku, z nieuleczalnymi schorzeniami w różnych stadiach choroby, nawet z prognozą życia liczoną w latach (konsultowani w poradniach medycyny paliatywnej), choć przeważają pacjenci starsi, z wieloma chorobami oraz prognozą życia liczoną w miesiącach (w opiece domowej) lub tygodniach (w stacjonarnej) [1,2]. Szacuje się, że na cukrzycę cierpi 20-34% pacjentów korzystających z opieki paliatywnej.…”