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Noh H, Bui C, Mack JW. Factors Affecting Hospice Use Among Adolescents and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2023; 12:151-158. [PMID: 35639128 PMCID: PMC10124177 DOI: 10.1089/jayao.2021.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background/Objective: Compared to existing studies on end-of-life care of mid- to older-aged patients diagnosed with cancer, there is a paucity of research on adolescents and young adult (AYA) patients. Guided by the Anderson's Behavioral Model for Healthcare Utilization, this study examined predisposing/enabling/need factors associated with hospice referral/enrollment among AYA patients diagnosed with cancer. Methods: Data were drawn from medical records of AYA patients who died of cancer between January 2013 and December 2016 at three academic sites in the United States and were 15-39 years old at the time of death. Logistic regression was conducted (N = 224). Results: Findings showed that hospice referral was strongly associated with hospice enrollment (odds ratio [OR] = 69.68, p < 0.0001). White patients were more likely to be referred to hospice care than non-White patients; the effect was, however, significant only among patients with private insurance (OR = 3.44, p = 0.040). Patients with public insurance were more likely to be referred to hospice than those with private insurance; the effect was, however, significant only among non-White patients (OR = 5.66, p = 0.005). Among those not receiving cancer treatment in the last month of life (LML), patients with hematologic malignancies were less likely to be referred to hospice than those with solid tumors (OR = 0.19). Among patients with solid tumors, receiving cancer treatment in the LML lowered the odds of hospice referral (OR = 0.50, p = 0.043). Conclusion: Further research efforts are needed to investigate the role of race, insurance, cancer types, and treatments in hospice use among bigger samples of AYA patients diagnosed with cancer.
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Affiliation(s)
- Hyunjin Noh
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Chuong Bui
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Jennifer W. Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
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Ullrich A, Grube K, Hlawatsch C, Bokemeyer C, Oechsle K. Exploring the gender dimension of problems and needs of patients receiving specialist palliative care in a German palliative care unit - the perspectives of patients and healthcare professionals. BMC Palliat Care 2019; 18:59. [PMID: 31315678 PMCID: PMC6637603 DOI: 10.1186/s12904-019-0440-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Gender disparities of specific symptoms and problems have frequently been observed in palliative care patients, but research rarely focused on the range of problems and needs affected by gender. Methods We conducted semi-structured interviews with patients and healthcare professionals (HCPs) of a hospital-based palliative care unit to examine gender effects on patients’ problems and needs based on systematically gathered qualitative data. Content analysis was used to identify emerging themes with data coded using MAXQDA. Results Ten patients (5 female, 5 male) and 17 HCPs (12 female, 5 male) were interviewed. Seven categories of gender-specific problems and needs emerged: “physical symptoms, care and body image”, “psychological symptoms and emotional response”, “interaction with the palliative care team”, “use of professional supportive measures”, “activation of informal social networks”, “decision-making”, and “preservation of autonomy and identity”. Both patients and HCPs felt that female patients adopt more expressive coping strategies, have stronger need for communication with and support of HCPs, and activate an extended social network for support and decision-making. Further, both groups thought that male patients mainly rely on social support from partners, have higher expectations to be cared for at home, and have higher need for preservation of autonomy. Conclusion Gender relevantly impacts patients’ problems and needs during palliative care. Therefore, gender-sensitive palliative care that acknowledges the patient’s individual situation and respective ramifications are required.
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Affiliation(s)
- Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hubertus Wald University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany.
| | - Kristina Grube
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hubertus Wald University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Cornelia Hlawatsch
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hubertus Wald University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hubertus Wald University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hubertus Wald University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany
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Lee GJ, Ahn HS, Go SE, Kim JH, Seo MW, Kang SH, Yang YR, Lee MY, Lee KO, Chun SH, Jin JY. Patient's Factors at Entering Hospice Affecting Length of Survival in a Hospice Center. Cancer Res Treat 2014; 47:1-8. [PMID: 25345463 PMCID: PMC4296857 DOI: 10.4143/crt.2013.148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 12/09/2013] [Indexed: 11/21/2022] Open
Abstract
PURPOSE In order to provide effective hospice care, adequate length of survival (LOS) in hospice is necessary. However the reported average LOS is much shorter. Analysis of LOS in hospice has not been reported from Korea. We evaluated the duration of LOS and the factors associated with LOS at our hospice center. MATERIALS AND METHODS We retrospectively examined 446 patients who were admitted to our hospice unit between January 2010 and December 2012. We performed univariate and multivariate analysis for analysis of factors associated with LOS. RESULTS The median LOS was 9.5 days (range, 1 to 186 days). The LOS of 389 patients (86.8%) was< 1 month. At the time of admission to hospice, 112 patients (25.2%) were completely bedridden, 110 patients (24.8%) had mouth care only without intake, and 134 patients (30.1%) had decreased consciousness, from confusion to coma. The median time interval between the day of the last anticancer treatment and the day of hospice admission was 75 days. By analysis of the results of multivariate analysis, decreased intake and laboratory results showing increased total white blood cell (WBC), decreased platelet count, increased serum creatinine, increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) level were poor prognostic factors for survival in hospice. CONCLUSION Before hospice admission, careful evaluation of the patient's performance, particularly the oral intake, and total WBC, platelet, creatinine, AST, ALT, and LDH level is essential, because these were strong predictors of shorter LOS. In the future, conduct of prospective controlled studies is warranted in order to confirm the relationship between potential prognostic factors and LOS in hospice.
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Affiliation(s)
- Guk Jin Lee
- Division of Hematology Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Hye Shin Ahn
- Division of Hematology Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Se Eun Go
- Division of Hematology Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Ji Hyun Kim
- Division of Hematology Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Min Wu Seo
- Division of Hematology Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Seung Hun Kang
- Division of Hematology Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Yeo Ree Yang
- Division of Hematology Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Mi Yeong Lee
- Division of Hematology Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Ku Ock Lee
- Hospice Unit, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Sang Hoon Chun
- Division of Hematology Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Jong Youl Jin
- Division of Hematology Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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Gupte KP, Wu W. Impact of anticholinergic load of medications on the length of stay of cancer patients in hospice care. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:192-8. [PMID: 24954119 DOI: 10.1111/ijpp.12132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 05/13/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES An important goal of hospice care is to relieve pain and suffering of terminal cancer patients. Anticholinergic medications are effective in the symptom palliation among terminal cancer patients. However, use of these medications has been associated with increased risk of side effects, which might lead to premature mortality. Short lengths of stay in hospice care leave patients with a higher level of unmet needs. The study was conducted to examine the effect of increasing anticholinergic load on the length of stay of cancer patients in hospice care in the USA. METHODS The National Home and Hospice Care Survey 2007 was used as the data source. The Cox proportional hazards model was used to investigate the risk of death among users of moderate and high anticholinergic load compared with users of low anticholinergic load in presence of other prognostic factors. KEY FINDINGS Cancer patients on a moderate anticholinergic load had a 12.7% lower hazard of death (P = 0.0244), while those on a high anticholinergic load had a 15.6% lower hazard of death (P = 0.0071) as compared with those patients on a low anticholinergic load. Among other prognostic factors, non-elderly age group, male gender, white race, metropolitan hospice agency, non-profit hospice agency, severe activities of daily living dependency and cognitive impairment were significantly associated with a higher probability of death. CONCLUSIONS These results provide no evidence for increasing anticholinergic load increasing mortality in cancer patients using hospice care. Thus, high anticholinergic load might have conferred a protective effect on the patients because of better symptom control.
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Affiliation(s)
- Komal P Gupte
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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Abstract
BACKGROUND Palliative care units provide non-curative treatment and support to patients with terminal illness. Brief end-of-life admissions are disruptive for patients and their families, and increase staff stress. Extremely rapid deaths (survival <24 h from admission) are particularly challenging for all involved. From 1 January 2010 to 23 August 2011, 256 patients died on the Palliative Care Unit (Caritas Christi) at St Vincent's Hospital Melbourne. Forty-two died within 24 h (16%), while 214 survived beyond 24 h (84%). AIMS A retrospective chart audit was conducted, aiming to identify factors characterising those patients who died within 24 h. METHODS Groups were compared for age, gender, country of birth, preferred language, ward of origin, primary pathology, time trends, whether an emergency code was called, Palliative Care Outcomes Collaboration (PCOC) phase, modified Karnofsky score and commencement of a syringe driver for medication. RESULTS Results showed that admission from neurosurgery (P= 0.0001), a vascular or infective pathology (P= 0.0001), PCOC phase ≥ 3 (P= 0.0001), modified Karnofsky score ≤ 20% (P= 0.0001), and commencement of a syringe driver prior to or at admission (P= 0.0001) were all significantly associated with death within 24 h of admission. On binary logistic regression, the only independent predictor of patients likely to die in <24 h from admission was PCOC phase ≥ 3 (P= 0.002).
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Trends in Length of Hospice Care From 1996 to 2007 and the Factors Associated With Length of Hospice Care in 2007. Am J Hosp Palliat Care 2013; 31:356-64. [DOI: 10.1177/1049909113492371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Using the National Home and Hospice Care Surveys, we examined trends in length of hospice care from 1996 to 2007 and the factors associated with length of care in 2007. Results suggest that the increasing average lengths of care over time reflect the increase in the longest duration of care. For-profit ownership is associated with hospice care received for over a year.
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Johnson KS, Kuchibhatla M, Tulsky JA. Racial differences in location before hospice enrollment and association with hospice length of stay. J Am Geriatr Soc 2011; 59:732-7. [PMID: 21410443 DOI: 10.1111/j.1532-5415.2011.03326.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
African Americans are less likely than Whites to enroll in hospice. In addition, patients are often referred to hospice very close to death, when they may not have time to take advantage of the full range of hospice services. Understanding how race and location before hospice enrollment are related to hospice length of stay (LOS) may inform the development of interventions to increase timely access to hospice care. Using data from a national hospice provider, African Americans and Whites admitted to routine home hospice care in a private residence between January 1, 2000, and December 31, 2003, were identified. Logistic regression was used to examine the association between race and hospice preadmission location (hospital vs other locations) and preadmission location and hospice LOS (≤7 days vs >7 days) after adjusting for demographic and hospice use variables. Of 43,869 enrollees, 15.3% were African American. One to 2 days before hospice enrollment, African Americans were more likely than Whites to be in the hospital than in all other locations (48.6% vs 32.3%, P<.001; adjusted odds ratio=1.83, 95% confidence interval=1.73-1.95). Regardless of race, those whose preadmission location was the hospital were more likely than those from other locations to die 7 days or less after hospice enrollment. Initiatives to improve end-of-life care should focus on increasing timely access to hospice referrals in settings outside of the hospital. Future research should examine whether racial differences in hospice preadmission location reflect differences in preferences for care or disparities in timely access to hospice referrals in non-acute care settings.
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Choi JY, Shin DW, Kang J, Baek YJ, Mo HN, Nam BH, Seo WS, Park JH, Kim JH, Jung KT. Variations in process and outcome in inpatient palliative care services in Korea. Support Care Cancer 2011; 20:539-47. [PMID: 21347522 DOI: 10.1007/s00520-011-1115-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 02/02/2011] [Indexed: 11/30/2022]
Abstract
PURPOSES Hospice programs in Korea have been largely based on volunteer activity, religious services, or social services. Recent government policy of designating medically based inpatient palliative care services and per diem payment system made it necessary to monitor the quality of these services. We examined the variation in the process and outcomes of palliative care services, using 2009 data obtained from the Korean Terminal Cancer Patient Information System. METHODS Data were collected from 3,867 patients with terminal cancer who were registered in 34 inpatient palliative care centers designated by the Ministry of Health and Welfare. We used the mean length of stay and the subsequent place of care as process indicators, and change in average pain score as an outcome indicator. The data were analyzed using descriptive statistics, and analysis of covariance for the case-mix adjustment. RESULTS There were considerable variations among services with regards to the mean length of stay (i.e., 10.5 to 32.6 days for each admission) and subsequent place of care (i.e., 39.8% to 92.6% ended in death at the first admission), even after stratification by service level. The mean change in average pain score varied from -1.48 to 2.16, and remained significant after case-mix adjustment. CONCLUSION We found considerable variations among palliative care services with regard to the mean length of stay, subsequent place of care, and change in average pain score. Continued assessment of the variations in process and outcomes will assist in developing the national benchmarking system and the evaluation of the government policy.
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Affiliation(s)
- Jin Young Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi, South Korea
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Chung K, Essex E, Samson LF. Ethnic variation in timing of hospice referral: does having no informal caregiver matter? J Palliat Med 2008; 11:484-91. [PMID: 18363492 DOI: 10.1089/jpm.2007.0149] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The length of hospice stay, as an indicator of timing of hospice referral, is an important outcome to examine in end-of-life care because it is relevant to the quality and cost efficiency of end-of-life care that patients receive. Although the majority receives nonmedical care from informal caregivers, many elderly hospice users rely on paid caregivers or staff of residential facilities. OBJECTIVE This study examined whether availability of informal primary caregiver interact with ethnicity to affect length of hospice stay. DESIGN A retrospective cross-sectional study. SETTING/SUBJECTS Data on 3024 hospice patients aged 65 and older discharged between 1997 and 2000 was extracted from the National Center for Health Statistics' National Home and Hospice Care Survey (NHHCS). MEASUREMENTS Length of hospice stay prior to death or discharge. RESULTS Survival analysis revealed that among patients with formal caregivers, minority patients were likely to have significantly shorter hospice stays than non-Hispanic whites. There were no significant ethnic differences in length of stay among patients with informal caregivers. CONCLUSIONS Our findings suggest that ethnic differences in length of stay should be discussed in terms of type of caregiver, not just type of setting, since patients in residential facilities can have informal primary caregivers who are vigilant advocates for their dying relatives. We discuss possible reasons for the influence of having formal caregivers on length of stay of minority elders.
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Affiliation(s)
- Kyusuk Chung
- Department of Health Administration, Governors State University, University Park, Illinois 60466, USA.
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Lin MH, Wu PY, Chen TJ, Hwang SJ. Analysis of long-stay patients in the Hospice Palliative Ward of a Medical Center. J Chin Med Assoc 2008; 71:294-9. [PMID: 18567559 DOI: 10.1016/s1726-4901(08)70125-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The Pilot Project on Per-diem Payment for Inpatient Hospice Services of Taiwan's National Health Insurance Program was begun in July 2000. The project monitors hospices to control for a median length of stay (LOS) of not longer than 16 days to prevent inappropriate stasis in hospices. To determine the best utilization of palliative care, patients remaining in the hospice for more than 28 days were analyzed to discover their characteristics and reasons for not being discharged. METHODS The study sample included 1,670 hospice patients who were admitted to the Hospice Palliative Unit in Taipei Veterans General Hospital between July 16, 1997 and December 31, 2002. Two hundred and sixty admissions (21.5%) with LOS > 28 days were identified. Further instrument survey of selected items was performed by 2 trained staff via chart review independently. The basic data were analyzed and comparison between long-stay patients and non-long-stay patients was made. RESULTS The mean LOS of 1,670 hospice patients was 16.0 +/- 14.9 days. Two hundred and sixty-eight patients (16.1%) admitted for longer than 28 days were surveyed. Those who had longer mean survival time, a diagnosis of prostate cancer, a metastatic site in the bone, and readmitted patients were associated with long stay. The study also revealed a significant difference in LOS between fee-for-service (FFS) patients and per-diem payment (PDP) patients (mean LOS, 17.5 +/- 16.4 vs. 14.3 +/- 13.4, p < 0.001). Conditions of major physical distress on Day 29 were delirium (41.9%), depression and/or anxiety (20.4%), and severe dyspnea (21.2%). The main reasons for being unable to be discharged on Day 29 after admission included "prolonged terminal phase" (34.2%), "difficult symptom control" (25.8%), "placement problem" (16.9%), and "need of parenteral medication" (15.0%). CONCLUSION Better understanding of the factors related to LOS can help staff in the palliative ward of medical centers to identify patients who are apt to have long stay, and shorten their LOS by successfully dealing with their problems.
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Affiliation(s)
- Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Schockett ER, Teno JM, Miller SC, Stuart B. Late referral to hospice and bereaved family member perception of quality of end-of-life care. J Pain Symptom Manage 2005; 30:400-7. [PMID: 16310614 DOI: 10.1016/j.jpainsymman.2005.04.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2005] [Indexed: 11/29/2022]
Abstract
The Family Evaluation of Hospice Services was used to document bereaved family members' perceptions of whether their loved ones were referred too late to hospice and to examine the association of that perception and quality of end-of-life care. A mortality follow-back survey of bereaved family members from two not-for-profit hospices found that 13.7% of decedents were referred at a time too late for hospice services. Family members of persons referred too late reported lower satisfaction with hospice services, a higher rate of unmet needs for information about what to expect at time of death, lower confidence in participating in patient care at home, more concerns with coordination of care, and lower overall satisfaction. Families reported physicians as an important barrier to earlier hospice referral in nearly one-half of cases. These results indicate a need for improved services for shorter-stay hospice patients/families and for physicians to help facilitate earlier hospice admission.
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Affiliation(s)
- Erica R Schockett
- Center for Gerontology and Health Care Research, and Department of Community Health, Brown Medical School, Providence, Rhode Island, USA
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Miller SC, Weitzen S, Kinzbrunner B. Factors Associated with the High Prevalence of Short Hospice Stays. J Palliat Med 2003; 6:725-36. [PMID: 14622452 DOI: 10.1089/109662103322515239] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study's goal was to gain an understanding of the factors associated with hospice stays of 7 days or less (i.e., short hospice stays), and to test the hypothesis that independent of changes in sociodemographics, diagnoses, and site-of-care, the likelihood of a short hospice stay increased over time. We examined hospice stays for 46655 nursing home and 80507 non-nursing home patients admitted between October 1994 and September 1999 to 21 hospices across 7 states, and owned by 1 provider. Logistic regression was used to determine the factors significantly associated with a higher probability of a short stay. Compared to patients admitted in (fiscal year) 1995, and controlling for potential confounders, the probability of a short stay significantly increased in each year after 1995 in nursing homes, and in 1999 in non-nursing home settings. In (fiscal year) 1995, a nursing home resident admitted to hospice had a 26% probability (95% confidence interval [CI] 0.24, 0.28) of a less than 8-day stay and, in (fiscal year) 1999, the probability was 33% (95% CI 0.31, 0.34); a non-nursing home patient had a 32% probability in 1995 (95% CI 0.30, 0.34) and a 36% probability in 1999 (95% CI 0.34, 0.37). The probability of a short hospice stay was greater for patients with noncancer diagnoses, independent of year of hospice admission. In this paper we discuss the possible underlying reasons for the increased probability of short hospice stays and we speculate on what this increase may mean in terms of hospice's ability to provide high-quality end-of-life care.
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Affiliation(s)
- Susan C Miller
- Center for Gerontology and Health Care Research, Brown University Medical School, Providence, Rhode Island 02912, USA.
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Lamont EB, Christakis NA. Physician factors in the timing of cancer patient referral to hospice palliative care. Cancer 2002; 94:2733-7. [PMID: 12173344 DOI: 10.1002/cncr.10530] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although physicians state that patients ideally should receive hospice care for 3 months before death, the majority of patients survive < 1 month in hospice care. In the current study, the authors attempted to determine whether the attributes of referring physicians were associated with the survival of terminally ill cancer patients in hospice. METHODS Using a prospective cohort study design, the authors observed the survival of 326 terminally ill cancer patients who were referred by 258 different physicians to 5 outpatient hospice programs in Chicago. The authors evaluated associations between patient, physician, and patient-physician relationship factors and patient survival. RESULTS Of the 326 participating patients, 313 (96%) had known dates of death. For these patients, the median survival was 26 days. Controlling for patient demographic and disease factors, there were several physician factors found to be associated with the length of patient survival after hospice referral. For example, when a physician had referred > or = 2 patients to hospice care in the previous 3 months, the patient survived 17 days longer in hospice compared with those patients whose physician referred fewer patients to hospice. When a physician estimated patient survival accurately (estimate obtained at the time of referral), the patient lived 20 days longer in hospice compared with those patients whose physicians made inaccurate survival estimates. The practice specialty of the physician also was found to be associated with patient survival after hospice referral, with patients referred by general internists and geriatricians living 18 days longer in hospice compared with those patients who were referred by oncologists. CONCLUSIONS In the current study, referring physician factors were found to be associated with the survival of terminally ill cancer patients after referral to hospice.
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Affiliation(s)
- Elizabeth B Lamont
- Sections of General Medicine and Hematology-Oncology, Department of Medicine and Cancer Research Center, University of Chicago, Chicago, Illinois, USA.
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Head B. The prognostication problem. HOME HEALTHCARE NURSE 2001; 19:535-6. [PMID: 11982190 DOI: 10.1097/00004045-200109000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
With increased focus on end-of-life care; prognosis may be finally receiving the attention it deserves. Hopefully, this will result in further research, the development of effective tools, and adequate education and training related to prognostication.
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Affiliation(s)
- B Head
- Hospice and Palliative Care of Louisville, 3532 Ephraim McDowell Drive, Louisville, KY 40205-3224, USA.
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