Recent data have indicated that hospice and palliative care services have increasingly fallen in line with patients’ and physicians’ goals of care, though utilization is lagging behind preferences.
Goals-of-care discrepancies
Cancer patients face a greater likelihood of receiving discordant care that misaligns with their end-of-life goals, according to recent research.
Cancer patients often report discrepancies between their goals of care and the treatments they receive, a recent study found. The study examined advanced care planning trends among 1,099 patients receiving care across multiple sites and was published in the journal Cancer, a publication of the American Cancer Society.
Researchers examined the stated and documented wishes of individuals with cancer and other advanced, serious and terminal illnesses, as well as their perceptions around the goal-concordant care they received.
About 49% of patients with advanced cancer who had a 24-month mortality trajectory had a preference for comfort-focused care versus life-extending treatment, which compared to 16% of individuals with other illnesses, the study found. Nearly one-quarter (24%) of the cancer patients with comfort care preferences indicated that they received discordant, or life-extending treatment, while 15% received goal-concordant care.
The findings indicate significant gaps when it comes to aligning with patient preferences, according to Dr. Maurie Markman, president of medicine and science, at City of Hope’s Cancer Centers in Atlanta, Chicago and Phoenix. Increased advanced care planning training among clinicians is needed to help address the issue, Markman indicated.
“We need to have concordance of those goals between what the patients say they want and the providers of that care. This is very well recognized now as being an absolutely essential component of both optimal and ethical care,” Markman said in commentary published in Medscape. “[There is] an element of concern related to this issue. This is a topic clearly worthy of a different approach [with] further explanation and understanding so we can increase the concordance of the patient’s stated goals and the care they are receiving.”
Hospice utilization after ICU stays rising
Hospice and palliative care utilization has been on the rise among patients after intensive care unit (ICU) stays, a recent study found.
Rates of discharges to hospice following an ICU visit have risen by roughly 6% or 7% during the past decade, the study found, which was published in Annals of the American Thoracic Society, an Oxford Academic journal. Researchers from Boston University’s School of Medicine examined trends of ICU discharges among 10 million Medicare beneficiaries between 2011and 2023.
Palliative care utilization rates reached 15% among patients following an ICU stay in 2023, nearly double the 7% rate in 2011.
The findings suggest that hospice and palliative care delivery may be expanding upstream, according to the research’s lead author Dr. Anica Law, assistant professor at Boston University and physician providing pulmonary, allergy, sleep and critical care at Boston Medical Center.
“ICU care is intense and invasive, and many of the life-sustaining treatments offered long-term may not be what patients want near the end of life,” Law told local news. “Seeing more people move to hospice suggests that hospitals may be focusing more on helping patients at high risk of death choose comfort-focused care.”
End-of-life choices among physicians vs. public
Patients and health care providers often prefer to have a hospice or home-based deaths, but many die in hospital settings. A lack of understanding and experience about home hospice care could be a leading factor.
This is according to research published in Annals of Internal Medicine, an American College of Physicians (ACP) journal. Better outcomes and lower levels of intensive care have been associated with hospice and home-based deaths. However, in-hospital deaths are more common than hospice mortalities, the research found.
Home and hospice death rates among physicians were slightly higher compared to other Americans, according to the research. Roughly 44.2% of physicians and 41.8% of registered nurses nationwide die at home or in hospice, according to the research. This compared to 40.6% of the general population.
Clinical knowledge of hospice, family caregiver support and socioeconomic resources were among the potential factors.
Driving the home-based death trends among physicians is a potential lack of personal hospice experience, according to lead author Dr. Anupam B. Jena, Joseph P. Newhouse Professor of Health Care Policy at Harvard Medical School. Jena is also a physician at Massachusetts General Hospital’s Department of Medicine.
“Physicians, given their professional experience with serious illness, might be more likely to choose home or hospice at the end of life,” Jena stated in an analysis. “However, prior work found little difference in hospital deaths between physicians and other highly educated adults …”
Companies featured in this article:
American Cancer Society, American College of Physicians, Boston University, City of Hope, Harvard Medical School, Massachusetts General Hospital, Oxford Academic
