Which Hospice Patients With Cancer Are Able to Die in the Setting of Their Choice? Results of a Retrospective Cohort Study

Abstract

A B S T R A C T PurposeTo determine which hospice patients with cancer prefer to die at home and to define factors associated with an increased likelihood of dying at home. MethodsAn electronic health record-based retrospective cohort study was conducted in three hospice programs in Florida, Pennsylvania, and Wisconsin. Main measures included preferred versus actual site of death. ResultsOf 7,391 patients, preferences regarding place of death were determined at admission for 5,837 (79%). After adjusting for other characteristics, patients who preferred to die at home were more likely to die at home (adjusted proportions, 56.5% v 37.0%; odds ratio [OR], 2.21; 95% CI, 1.77 to 2.76). Among those patients (n ϭ 3,152) who preferred to die at home, in a multivariable logistic regression model, patients were more likely to die at home if they had at least one visit per day in the first 4 days of hospice care (adjusted proportions, 61% v 54%; OR, 1.23; 95% CI, 1.07 to 1.41), if they were married (63% v 54%; OR, 1.35; 95% CI, 1.10 to 1.44), and if they had an advance directive (65% v 50%; OR, 2.11; 95% CI, 1.54 to 2.65). Patients with moderate or severe pain were less likely to die at home (OR, 0.56; 95% CI, 0.45 to 0.64), as were patients with better functional status (higher Palliative Performance Scale score: Ͻ 40, 64.8%; 40 to 70, 50.2%; OR, 0.79; 95% CI, 0.67 to 0.93; Ͼ 70, 40.5%; OR, 0.53; 95% CI, 0.35 to 0.82). ConclusionIncreased hospice visit frequency may increase the likelihood of patients being able to die in the setting of their choice.

The “Comfortable Dying” Measure: How Patient Characteristics Affect Hospice Pain Management Quality Scores

“…Of course, the choice of setting of care is driven largely by patient and family preferences, and many patients may prefer to receive hospice care at home. 17 Furthermore, hospices need to justify an inpatient admission. Nevertheless, increased use of inpatient care, within the bounds of regulatory requirements and patient/family preferences, would seem to offer a potentially important opportunity to improve pain management.…”

Patient Preferences versus Family Physicians' Perceptions Regarding the Place of End-of-Life Care and Death: A Nationwide Study in Taiwan

“…27 As patients approach death, they might feel safer in institutional settings, particularly if there is at home a lack of support and resources for the patients or their caregivers. 16,28 To allow more people to die in their preferred places, doctor-patient communication during end-of-life care should be enhanced. The National Health Insurance in Taiwan began in December 2012 to allow billing for family meetings for hospitalized terminally ill patients to facilitate communication in advanced care planning.…”

“…15,16 In Taiwan, palliative care is offered as inpatient care, hospital-based shared care, and home care. Most palliative care is provided in urban hospitals, because the patient volumes at these institutions are sufficiently large to allow staff members to specialize in palliative medicine.…”

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

“…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.…”