Hospice care underused by many terminally ill
Hospice care underused by many terminally ill
Hospice, a well-established approach to palliative care, has enabled countless people worldwide to die with dignity, according to a released statement from Harvard Medical School in Boston. Through focusing on the patient rather than the disease, individuals can spend the last weeks of their lives in an environment where hospice caregivers minimize their pain, maximize their comfort, and provide bereavement services for loved ones and family members, the statement says.
A new study led by researchers at Harvard Medical School, however, found that only about half the patients diagnosed with metastatic lung cancer discuss hospice with their physician within four to seven months of their diagnosis.1
"Many terminally ill patients who might benefit from hospice aren't discussing it with their physicians and may not be aware of the services hospice could offer," says Haiden Huskamp, PhD, lead author on the study and an associate professor of health care policy at Harvard Medical School.
Through the Cancer Care Outcomes Research and Surveillance Consortium, the researchers surveyed 1,517 patients diagnosed with metastatic lung cancer. For reasons not clear, blacks and Hispanics were less likely to discuss hospice than whites and Asians. Forty-nine percent of blacks and 43% of Hispanics discussed hospice with their doctors; for whites and Asians the percentages were 53 and 57, respectively. Married people were less likely than unmarried people to have this discussion (51% compared with 57%, respectively).
Life expectancy is a factor
In general, the longer patients expected to live after their diagnosis, the less likely they were to have explored hospice care with their doctor. However, the researchers also found that patients tended to overestimate how long they had to live. For example, about 30% of the patients thought that they would live up to two years. In reality though, only about 6% of patients with metastatic lung cancer will survive that long.
What's more, patients who preferred care that eased their pain and suffering at the end of life over care that extended life (roughly 50% of patients) were no more likely to have discussed hospice than patients who had the opposite preference.
"These conversations can be difficult for everyone involved: patients, families, and physicians," says Huskamp. "But discussing prognosis and end-of-life care options in advance is essential to make sure that patients receive care that reflects their wishes."
Better symptom management
Hospice care has been shown to result in better symptom management and quality at the end of life, the researchers say. Average survival after diagnosis with metastatic lung cancer is four to eight months, so it is particularly concerning that only half the patients in this group discussed the service with their physicians within this time frame, they say.
John Ayanian, MD, MPP, senior author on the study and professor of medicine and health care policy at Harvard Medical School, says, "Patients with advanced lung cancer understandably hope that cancer treatments can extend their lives. When these treatments are no longer working, their doctors have an important role to play in offering them hospice care that will ease their symptoms as they approach the end of life."
The authors contend that improved communication between doctors and patients is needed to educate patients about end-of-life care options and ensure that patients understand their prognosis.
This study was funded by the National Cancer Institute.
Reference
1. Huskamp HA, Keating NL, Malin JL, et al. Discussions with physicians about hospice among patients with metastatic lung cancer. Arch Int Med 2009; 169:954-962.
Hospice, a well-established approach to palliative care, has enabled countless people worldwide to die with dignity, according to a released statement from Harvard Medical School in Boston.Subscribe Now for Access
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