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End-of-Life Patient Satisfaction Hinges on Longer Hospice Care

Patients receiving hospice care for a longer period of time are more likely to have high end-of-life patient satisfaction, research suggests.

By Sara Heath

Hospice care plays an important role in improving patient satisfaction and fulfilling end of life wishes for patients with cancer, according to a recent study published in the Journal of Clinical Oncology, but the benefits are dependent upon the duration of the service.

hospice-care-patient-satisfaction

According to the research team, hospice care offers a solution to an array of problems cancer patients face.

“Patients with advanced cancer often experience pain, dyspnea, and distress at the end of life (EOL), and use intensive, hospital-based services near death,” the researchers said. “Hospice offers an alternative, patient-centered model of care focused on relieving suffering, and often delivers services within the home environment.”

However, according to the researchers, positive effects of hospice care can depend upon a few external factors, most prominently length of stay.

To better understand the benefits of hospice care on colorectal and lung cancer patients, the research team looked at interviews with families of patients who died in 2011. These interviews, a part of the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium, included questions about the patient’s quality of life, pain management, and fulfillment of end-of-life wishes.

The researchers examined a cohort of 1,970 patients, half of whom were a control group receiving no hospice care. The other half did receive hospice care.

The researchers found that patients receiving hospice care tended to experience better end-of-life treatment than those who did not. Ninety-one percent were administered medication to manage pain symptoms, compared to 81 percent of control patients who reported the same.

Importantly, families of patients receiving hospice care reported that their pain management regimens were appropriately tailored for their symptom levels, a key component of quality care and patient satisfaction.

“Although patients enrolled in hospice have more symptoms, their symptoms are better controlled overall,” the researchers explained. “Of note, the families of patients enrolled in hospice were not more likely to report that patients received ‘too much’ pain medicine; rather, they were more likely to report that patients received ‘just the right amount.’”

Specifically, 80 percent of families said their loved ones received “just the right amount” of pain medication. This compares to 73 percent of control patients.

Eighty percent of families also reported that hospice patients were more likely to have their end-of-life wishes fulfilled. Seventy-four percent of control patients reported the same.

The researchers also found that the positive effects of hospice care increased alongside duration of stay. For example, families of patients who spent a shorter time in hospice care (defined as less than or equal to three days) were less likely to report that patients died in their preferred place.

The researchers noted that the relationship between hospice care effectiveness and duration was not linear. The difference between patients receiving little (less than three days) and moderate (between three and eight days) hospice care was negligible. The starkest difference emerged when patients entered hospice care 30 or more days prior to death.

These findings suggest that providers should prioritize early enrollment in hospice care when possible. Although this may not be realistic for all patients, the researchers say clinicians should make efforts to increase the median length of stay for hospice care from the current 17.4 days.

To that end, the researchers suggest amending hospice clinical quality measures (CQMs).

Currently, the American Society of Clinical Oncology uses “administering hospice care” as a cancer treatment clinical quality measure. The CQM currently focuses on administering hospice care for three to seven days; however, the researchers say industry leaders should focus on enrolling patients in hospice care earlier in end-of-life care.

Additionally, more research should be conducted to understand how to better deliver hospice care that fulfills all patient needs, regardless of duration of stay.

“Future studies should examine whether multifaceted approaches might result in the provision of more preference-sensitive, high-quality, and value-based EOL care for patients with cancer,” the researchers concluded.

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