Hospice Leads to Higher Satisfaction for Kidney Disease Patients

Care focused on extending life rather than comfort among patients with advanced chronic kidney disease correlated with lower patient and family satisfaction whether or not the patients had received dialysis, according to a recent study published in the Clinical Journal of the American Society of Nephrology. Receipt of hospice or palliative care was associated with higher levels of satisfaction.

A team of researchers conducted a nationwide retrospective observational study among a 9,993 veterans with advanced chronic kidney disease who died in U.S. Department of Veterans Affairs facilities between 2009 and 2015. The team evaluated associations between patterns of end-of-life care and receipt of dialysis with levels of satisfaction reported by families following patients’ deaths.

“After adjustment for patient and facility characteristics, receipt of maintenance (but not acute) dialysis and more intensive patterns of end-of-life care were associated with lower overall family ratings of end-of-life care,” the study indicated. “Whereas receipt of palliative care and hospice services were associated with higher overall ratings.”

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About 52% of the veterans included in the study spent less than two weeks in the hospital during the last 90 days of their lives; about 34% underwent an intensive procedure, and close to half were admitted to the intensive care unit.

Only 38% of the veterans received a palliative care consultation during the last 90 days of life, and 36% were receiving hospice services at the time of death. Most of the patients, 55% did not receive dialysis.

Overall in the hospice space, families tend to report positively regarding their deceased family member’s care experiences. The U.S. Centers for Medicare & Medicaid Services (CMS) requires hospices to provide the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to families following a hospice patient’s death.

Scores on family satisfaction surveys are generally high, according to the Medicare Payment Advisory Commission (MEDPAC), though the commission has noted that hospices had more room for improvement on the survey measures than the seven quality measures on which CMS requires hospices to report data. .

Hospice CAHPS scores are highest on factors related to providing emotional support and treating patients with respect. Approximately 90% of families selected the most positive response for those practices, MEDPAC has indicated.

The lowest scores were in the areas of providing help for pain and symptoms, providing timely care, and caregiver training, with an average of 75% to 78% of families giving the most positive response.

In overall assessments of the hospice, nearly 81% of CAHPS respondents rate the hospices a 9 or 10 on a 10-point scale.