Recent research has found that varying state laws around palliative care can impact cancer patients’ place of death.
Cancer patients in states with laws that require health care providers to provide palliative consultations were more likely to die in the home or in an inpatient hospice setting versus the hospital, a JAMA Network Open study found.
The cohort study analyzed site-of-death data from 2005 through 2017, including more than 7.5 million individuals with cancer across the 50 states (but not the District of Columbia). Researchers compared trends among states that had palliative care lows on their books against those that did not.
During that time frame, “prescriptive” palliative laws stipulating that health care providers communicate all end-of-life care options was associated with a 12% to 18% increased likelihood of cancer patients dying at home or in hospice, researchers found.
Researchers included Dr. Main Lin Quan Vega from the Columbia University of Physicians and Surgeons, and Stanford Chihuri and Deven Lackraj, both from George Washington University.
“These findings suggest that state palliative care laws are associated with an increase in the likelihood of dying at home or in hospice among decedents from cancer,” the researchers stated. “The passage of state laws related to communication about palliative care options increases the likelihood that patients with cancer will spend their final days at home or in hospice care, rather than undergoing aggressive treatment interventions in hospitals or other health care settings.”
More than half (50.1%) of cancer decedents in the study died at home or in hospice, the JAMA study found.
The wide variety of palliative care legislation across state lines can complicate cancer patients’ trajectories at the end of life, including where they die, according to JAMA researchers.
“Passage of state palliative care legislation may be an effective policy intervention to increase the number of seriously ill patients who experience their death in such locations,” Quan Vega, Chihuri and Lackraj said.
State laws to promote palliative care have proliferated during the last decade. These laws have focused on categories such as payment, workforce and clinical skill-building, public awareness, quality standards and specialized pediatric palliative care.
About 18 states have passed some type of palliative care legislation since 2014, according to Yale University’s Palliative Care Law and Policy GPS data tracker.
Georgia is among the most active, passing nine palliative bills since January 1, 2020, the data showed. Maryland fell second in line with seven bills passed, followed by Virginia with six bills passed and Arkansas and Colorado passed five and four bills, respectively.
New York last year passed a law designed to raise palliative and hospice awareness. It required the New York State Department of Health to develop a public awareness campaign to promote advance care planning. The campaign included education about hospice and palliative care.
New Jersey, Wisconsin, Oregon and Florida, all have laws that require certain providers to inform patients of those health care options in particular medical circumstances.
One common approach among the states is to establish an advisory council to study related issues and make recommendations to state agencies on further action.
Currently, 25 states have passed legislation creating such advisory groups, National Academy for State Health Policy (NASHP) reported.
Other approaches include looking at ways to reach patients further upstream in the continuum, such as instilling advance care planning or other consultative palliative communications into health care policy structures, JAMA researchers indicated.
“An effective state-level intervention is appealing, as it necessarily has a broader reach than a patient-level intervention and may require fewer additional resources,” Quan Vega, Chihuri and Lackraj wrote. “Interventions at this level could complement or enhance already established interventions at the individual level, such as the physicians orders for life-sustaining treatment or advance care planning, in prompting high-quality communication among clinicians, patients and their health care proxies to ensure that patients’ goals of care are honored at the end of life.”