Utilization and Cost of Services in the Last 6 Months of Life of Patients With Cancer - With and Without Home Hospice Care

Purpose To determine whether hospice use by patients with cancer is associated with their families’ perceptions of patients’ symptoms, goal attainment, and quality of end-of-life (EOL) care. Methods We interviewed 2,307 families of deceased patients with advanced lung or colorectal cancer who were enrolled in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) and died by 2011. We used propensity-score matching to compare family-reported outcomes for patients who did and did not receive hospice care, including the presence and relief of common symptoms (ie, pain, dyspnea), concordance with patients’ wishes for EOL care and place of death, and quality of EOL care. We also examined associations between hospice length of stay and these outcomes among hospice enrollees. Results In a propensity-score-matched sample of 1,970 individuals, families of patients enrolled in hospice reported more pain in their patient compared with those not enrolled in hospice. However, families of patients enrolled in hospice more often reported that patients received “just the right amount” of pain medicine (80% v 73%; adjusted difference, 7 percentage points; 95% confidence interval [CI], 1 to 12 percentage points) and help with dyspnea (78% v 70%; adjusted difference, 8 percentage points; 95% CI, 2 to 13 percentage points). Families of patients enrolled in hospice also more often reported that patients’ EOL wishes were followed (80% v 74%; adjusted difference, 6 percentage points; 95% CI, 2 to 11 percentage points) and “excellent” quality EOL care (57% v 42%; adjusted difference, 15 percentage points; 95% CI, 11 to 20). Families of patients who received > 30 days of hospice care reported the highest quality EOL outcomes. Conclusion Hospice care is associated with better symptom relief, patient-goal attainment, and quality of EOL care. Encouraging earlier and increased hospice enrollment may improve EOL experiences for patients with cancer and their families.

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Hospice Use Among Patients With Cancer: Trends, Barriers, and Future Directions

JCO Oncology Practice ◽

10.1200/op.20.00309 ◽

2020 ◽

Vol 16 (12) ◽

pp. 803-809

Author(s):

Mihir N. Patel ◽

Jonathan M. Nicolla ◽

Fred A.P. Friedman ◽

Michala R. Ritz ◽

Arif H. Kamal

Keyword(s):

End Of Life ◽

Advanced Cancer ◽

End Of Life Care ◽

Hospice Care ◽

Rapid Development ◽

Spiritual Needs ◽

Life Care ◽

General Acceptance ◽

Patients With Cancer ◽

Hospice Use

Patients with advanced cancer and their families frequently encounter clinical and logistical challenges related to end-of-life care. Hospice provides interdisciplinary and holistic care to meet patients’ biomedical, psychosocial, and spiritual needs in the last phases of life. Despite increasing general acceptance and use among patients with cancer, hospice remains underused. Underuse stems from ongoing misconceptions regarding hospice and its purpose, coupled with the rapid development of novel anticancer treatments, such as immunotherapies and targeted therapies, that have changed the landscape of possibilities. Furthermore, rapid evolutions in how end-of-life care is structured and reimbursed for will affect how oncology patients will intersect with hospice care. In this review, we explore the current and future challenges to greater integration of hospice care in the care of patients with advanced cancer and propose five recommendations as part of the path forward.

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Hope of Recovery in Patients in the Terminal Phase of Cancer under Palliative and Hospice Care in Poland

BioMed Research International ◽

10.1155/2020/7529718 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Bożena Baczewska ◽

Bogusław Block ◽

Beata Kropornicka ◽

Antoni Niedzielski ◽

Maria Malm ◽

...

Keyword(s):

Palliative Care ◽

Hospice Care ◽

Terminal Phase ◽

Family Socioeconomic Status ◽

Terminally Ill Cancer Patients ◽

Patients With Cancer ◽

Causal Treatment ◽

Low Levels ◽

The Individual ◽

Oncologic Therapy

Introduction. The objective of the presented research is to characterize hope in the situational dimension, i.e., health, in the patients with cancer in the terminal phase of the disease, being treated in hospices and palliative care centers. Hope is very important for all the patients, especially for patients with cancer in various phases of the disease. Giving up on oncologic therapy and causal treatment is often associated with a transition into palliative care. When death and a loss of values become a threat, the individual has got hope to rely on. Material and Methods. The study relies on the Test to Measure Hope in the Health Context (NCN-36) by B.L. Block. 246 patients in the terminal phase of cancer participated in the study. Results. The internal structure of hope of recovery in the patients’ group was varied. The patients showed low levels of hope of recovery since they do not believe in the effectiveness of treatment. They were also not convinced of the effectiveness of modifications in dieting, lifestyle, or the use of nonconventional medicine. They trusted the doctor in charge and were moderately satisfied with the therapy in use. The intensity of hope of recovery was on the low level in the patients in the terminal phase of cancer. Age, sex, place of living, and marital status had a significant influence on the level of hope of recovery. Variables such as living on one’s own or living with one’s family, socioeconomic status, education, or profession did not affect the level of hope of recovery. Conclusions. The presented results allowed as to conclude that the assessment of hope in terminally ill cancer patients can be considered as one of the important tools enabling the personalization and the improvement of palliative care.

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Frequency of Outpatient Antibiotic Prescription on Discharge to Hospice Care

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02873-14 ◽

2014 ◽

Vol 58 (9) ◽

pp. 5473-5477 ◽

Cited By ~ 18

Author(s):

Jon P. Furuno ◽

Brie N. Noble ◽

Kristi N. Horne ◽

Jessina C. McGregor ◽

Miriam R. Elman ◽

...

Keyword(s):

Acute Care ◽

Hospice Care ◽

Antibiotic Prescription ◽

Bloodstream Infections ◽

Cross Sectional Study ◽

Index Admission ◽

Data Repository ◽

Cross Sectional ◽

Documented Infection ◽

Home Hospice Care

ABSTRACTThe use of antibiotics is common in hospice care despite limited evidence that it improves symptoms or quality of life. Patients receiving antibiotics upon discharge from a hospital may be more likely to continue use following transition to hospice care despite a shift in the goals of care. We quantified the frequency and characteristics for receiving a prescription for antibiotics on discharge from acute care to hospice care. This was a cross-sectional study among adult inpatients (≥18 years old) discharged to hospice care from Oregon Health & Science University (OHSU) from 1 January 2010 to 31 December 2012. Data were collected from an electronic data repository and from the Department of Care Management. Among 62,792 discharges, 845 (1.3%) patients were discharged directly to hospice care (60.0% home and 40.0% inpatient). Most patients discharged to hospice were >65 years old (50.9%) and male (54.6%) and had stayed in the hospital for ≤7 days (56.6%). The prevalence of antibiotic prescription upon discharge to hospice was 21.1%. Among patients discharged with an antibiotic prescription, 70.8% had a documented infection during their index admission. Among documented infections, 40.3% were bloodstream infections, septicemia, or endocarditis, and 38.9% were pneumonia. Independent risk factors for receiving an antibiotic prescription were documented infection during the index admission (adjusted odds ratio [AOR] = 7.00; 95% confidence interval [95% CI] = 4.68 to 10.46), discharge to home hospice care (AOR = 2.86; 95% CI = 1.92 to 4.28), and having a cancer diagnosis (AOR = 2.19; 95% CI = 1.48 to 3.23). These data suggest that a high proportion of patients discharged from acute care to hospice care receive an antibiotic prescription upon discharge.

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