Provided as an educational service by St Joseph Hospice Vol. 13, Issue 3 Nov/Dec/Jan 2011-2012 National Study Finds Further Evidence That Hospice Use Does ‘Not Compromise Survival’ Bolstering other recent findings that hospice care does not shorten — and may even prolong — survival among “Appropriate timing of referral to hospice gives terminally ill cancer patients with cancer, an international patients and their families more time and opportunity to benefit team of researchers reports that Medi- from palliative services and avoid futile interventions. Concern care hospice patients have a slight sur- vival advantage over their nonhospice about hastening death should not be a barrier to hospice care.” counterparts. Further, aggressive care — Saito et al, Journal of Palliative Medicine delivered late in the illness is more likely merely to shorten hospice stay than to extend life. have comparable or even longer sur- KEY FINDINGS: “Despite a significant relationship vival compared to nonhospice patients, • Survival was found to favor hospice between aggressive care at the end of based on three different statistical ap- patients relative to nonhospice pa- life and no or only short-term hospice proaches,” write the authors of a re- tients by 5.0% at one year follow- stay, hospice patients were found to port published in the Journal of Pal- ing diagnosis (25.7%, hospice pa- liative Medicine. tients vs 20.7%, nonhospice) and by The team conducted multiple analy- 1.4% at two years post-diagnosis Inside: ses of data on Medicare patients (n = (6.9% vs 5.5%). NewsLine .............................2-3 7879) who survived for at least three • Longer-term hospice patients had 3 Achieving Equitable Access to Quality months following diagnosis of non- longer survival than nonhospice Hospice and Palliative Care: We’re at small-cell lung cancer between 1991 the ‘Tipping Point,’ Declares Expert patients (hazard ratio [HR], 0.87; and 1999. Patients were divided into Research Monitor ...............4-6 95% confidence interval [CI], 0.83 matched “hospice” and “nonhospice” to 0.91; p = 0.0001). 3 When Patients Have Multiple groups, with the hospice group further Comorbidities: The Challenges of • Short-term hospice patients had a End-of-Life Discussions without divided according to length of stay: similar, although slight, survival ad- One Clear Terminal Diagnosis “short term” (< 3 days in hospice) or 3 vantage compared with patients in Timely Receipt of Hospice Services “longer term” (> 4 days in hospice). Yields Higher Family Perceptions the nonhospice group (HR, 0.94; of Quality of Nursing Home Death Indicators of “aggressive care” near among Dementia Patients 95% CI, 0.83 to 1.05; p = 0.26). the end of life included: a new chemo- 3 New Accreditation Standards from the • Hospice patients with short-term ad- American College of Surgeons Focus on therapy regimen begun less than 30 missions were more likely to be male, Patient-Centered, Supportive Approach days before death; receiving a last dose to Hospice and Palliative Care urban dwellers, and to have received 3 Informing Patients of Impending Death of chemotherapy within 14 days of aggressive care near the end of life. Linked to Improved End-of-Life Care, death; more than one emergency de- with No Increase in Pain or Anxiety partment visit or hospital admission in OVERALL: Clinician Resources ..............7 the last month of life; or being hospi- • 47.9% of all patients received hos- 3 Approach to Addressing Cultural talized for longer than 14 days in the Beliefs and Preferences pice care. final month. Continued on Page 3 NEWSLINE Achieving Equitable Access to Quality Hospice and Palliative Care: We’re at the ‘Tipping Point,’ Declares Expert Caring for the sickest Medicare beneficiaries — the 10% with serious illness or multiple chronic conditions — ac- Policy Focus for Improving Access counts for 57% of the total program spending, yet studies to Quality Palliative Care demonstrate that these patients and their families are re- ceiving health care of inadequate quality. The dual goals • Enhance the medical and nursing workforce with ex- of cutting expenditures and delivering the care that patients pertise in palliative care need and desire can be achieved by strengthening access • Invest in the field’s research evidence base to quality palliative care and hospice. • Increase availability of services in hospitals and nurs- That is according to an article published in the Septem- ing homes ber issue of The Milbank Quarterly, a peer-reviewed, — Meier, The Milbank Quarterly multidisciplinary journal of population health and health policy. The article reviews the benefits of palliative care and the barriers to its delivery, and suggests policy ap- clarity of the care plan, and consistent follow-through proaches for standardizing access to high-quality care. • Easing the burden experienced by families and in- “Palliative care and hospice services improve patient- creasing satisfaction by supporting families in routine centered outcomes such as pain, depression, and other care, in crisis, and in bereavement symptoms; patient and family satisfaction; and the re- COST SAVINGS OF PALLIATIVE CARE AND HOSPICE ceipt of care in the place that the patient chooses,” writes author Diane E. Meier, MD, professor of geriatrics and Recent data show that the average per-patient, per-ad- palliative medicine at the Mount Sinai School of Medi- mission, net cost saved by using hospital palliative care cine, New York City. consultation is $2659, which translates into an estimated “By helping patients get the care they need to avoid un- $1.2 billion saved per year by the programs currently es- necessary emergency department and hospital stays and tablished at more than 60% of U.S. hospitals. Meier points shifting the locus of care to the home or community, pallia- out that this figure could increase to $4 billion saved, if tive care and hospice reduce health care spending for appropriate hospital palliative care services were expanded America’s sickest and most costly patient populations.” to meet the needs of most patients who are currently dis- charged with serious and complex chronic illness without PALLIATIVE CARE AND HOSPICE TEAMS: benefit of these services. DELIVERING HIGH-QUALITY CARE Hospice care, currently provided to over 1.5 million pa- Much of the strength of palliative care services lies in tients yearly, has been shown to reduce total health care their coordinated, patient-centered, multidisciplinary ap- costs by an estimated $2300 per Medicare beneficiary, with proach. Palliative care and hospice teams improve quality an average annual savings of more than $3.5 billion per of care by: year. When patients disenroll from hospice, their medical • Identifying and rapidly treating distressing symptoms costs are nearly five times higher than for those who re- that are shown to increase medical complications and main in hospice care, Meier points out. hospitalization The United States is unique in its categorization of pal- • Planning for safe transitions from acute care to more sup- liative care into two distinct types, notes Meier, in that it portive settings, such as home health care, home or in- labels “palliative care” as needs-based, with no prognostic patient hospice, or nursing home care with hospice restriction, and “hospice” as palliative care that is restricted • Avoiding nonbeneficial or harmful tests, procedures, or to patients with a prognosis of living six months or less. specialty consultations The relatively new field of palliative care outside of hos- • Meeting often with patients and families to establish real- pice has been created largely by private sector contribu- istic goals, leading to better-informed decision making, Continued on Page 3 PAGE 2 QUALITY OF LIFE MATTERS NOV/DEC/JAN 2011-2012 NEWSLINE National Study Finds Further Evidence That Hospice Use Does ‘Not Compromise Survival’ Continued from Page 1 cancer patients nearing death, the authors point out. “Ad- vances in medical technologies and a perception that pa- • 92.6% of the hospice patients died under hospice care, tients favor receiving aggressive care even very near death while only 2.8% died in a hospital. for small expected benefits may reduce the number of pa- • In contrast, 39.7% of nonhospice patients died in an acute tients referred to hospice,” they suggest. care setting. Nevertheless, the authors state firmly in their conclusion, • Hospice patients were older, more likely to be non-His- “[the] use of hospice and length of hospice stay for Medi- panic white and female, and more likely to live in urban care patients with advanced non-small-cell lung cancer did areas with high hospice availability. not compromise survival.” “[R]egional availability of hospice was associated with Source: “Hospice Care and Survival among Elderly Patients with Lung any hospice use, but not with length of hospice stay,” the Cancer,” Journal of Palliative Medicine; August 2011; 14(8):929-939. Saito AM, Landrum MB, Neville BA, Ayanian JZ, Weeks JC, Earle CC; authors point out. “Instead, experiencing aggressive end- Laboratory of Clinical, Epidemiological, and Health Services Research, of-life care was more predictive of shorter duration of hos- Clinical Research Center, National Hospital Organization Nagoya pice use.” Medical Center, Aichi, Japan; Department of Health Care Policy, Harvard Medical School, Boston; Division of Population Sciences, Department of Despite the results of recent studies showing that hos- Medical Oncology, Dana-Farber Cancer Institute, Boston; Division of General Medicine, Brigham and Women’s Hospital, Boston; Cancer Care pice care does not hasten death, there is a current trend in Ontario, Ontario Institute for Cancer Research, and the Institute for this country toward increasingly aggressive care among Clinical Evaluative Sciences, Toronto. Achieving Equitable Access to Quality Hospice and Palliative Care: We’re at the ‘Tipping Point,’ Declares Expert Continued from Page 2 oped by the American Academy of Hospice and Pallia- tions and initiatives from major professional organizations.