Talking About Hospice Eases People's Last Days

NEW YORK (Reuters Health) - Informing doctors which of their nursing home patients would likely benefit from hospice increases the chance the patients will enroll in hospice care, where they tend to receive better help and support in their last days of life, according to new study results.

Study author Dr. David Casarett told Reuters Health: "Some of our previous research has found that patients and families often wait for physicians to start discussions about hospice. And they wait. And wait. And wait."

"By helping patients and families to have these difficult discussions with a health care provider, we were able to overcome that barrier, and give more people access to hospice earlier in the course of their illness," added the researcher, based at the University of Pennsylvania in Philadelphia.

In the Journal of the American Medical Association, Casarett and his colleagues note that nearly 1 in 4 Americans dies in a nursing home, where there is often less than "optimal" end-of-life care.

For instance, 25 percent of nursing home residents with daily cancer pain typically do not receive pain medications, and many residents often spend their last weeks of life in acute care, where they undergo aggressive treatment.

Not surprisingly, many families say they are dissatisfied with the care loved ones received at a nursing home during their last days, the authors note.

Only 1 in 4 nursing home residents enrolls in additional hospice care, where a team experienced in helping dying patients comes to a nursing home to care for residents who are at the end of their lives. Studies show that patients receiving hospice care are more likely to experience good pain management, and less likely to be given inappropriate medications.

To investigate whether talking about hospice with doctors encourages patients to enroll, Casarett and his team interviewed 205 nursing home residents and their surrogate decision makers. The residents were split into two groups - for one group, the researchers informed doctors which of their patients would likely benefit from additional hospice care, and said nothing to the doctors of the patients in the other group.

Casarett explained that he and his colleagues hoped that telling doctors which patients would benefit from hospice care would "jump-start" discussions about end-of-life care and hospice.

The researchers found that people whose doctors were told they would benefit from hospice were significantly more likely to ask for hospice care, and spent less time in acute care. Families of residents who received the intervention also tended to say they were more satisfied with their loved one's end-of-life care.

"Hospice is not for everyone, and we're not all ready to think about hospice at the same time," Casarett noted. "But all nursing home residents and their families -- in fact, all patients -- should know that hospice may be able to help them."

He added that, in some cases, patients may have to bring up hospice care themselves. "Don't wait until your health care provider suggests hospice as an option-ask," Casarett advised. "The best time to learn about hospice is before you need it."

SOURCE: Journal of the American Medical Association, July 13, 2005.