17 Dec Hospice Care: Discussed Earlier by Physicians Who Would Enroll Themselves if Terminally Ill
MedicalResearch.com Interview with:
Garrett M. Chinn, MD, MS
Division of General Medicine, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston
MedicalResearch.com: What are the main findings of this study:
Dr. Chinn: Despite the desire of most Americans facing terminal illness to spend their remaining time at home, only 24% of those aged 65 and older do so. Many spend their final days in an institutional setting such as an acute care hospital, often receiving aggressive care.
In the case of patients facing stage 4 lung cancer, many who would prefer to emphasize pain relief over extending life report not having discussed hospice with a physician. More than 25% indicate that they had not addressed advanced care directives such as do-not-resuscitate orders with their doctors but wanted to do so. This tells us that patients wish to better understand their illness and prognosis and might be interested in learning about hospice. And although the general trend for hospice utilization has increased over the past decade, a high percentage of hospice enrollment occurs quite late in the course of illness, often during an acute hospitalization.
In an effort to identify factors which might affect timely discussions about hospice, we wondered whether or not physicians who had more positive attitudes toward hospice themselves were more likely to have early discussions about hospice with their cancer patients. Women, primary care physicians, and those working in managed-care settings or who worked with more terminally-ill and managed-care patients were more likely to strongly agree with the statement:
If I were terminally ill with cancer, I would enroll in hospice?
Physicians who strongly agreed with that statement were more likely to have earlier, timely discussions about hospice with a terminally-ill cancer patient with a prognosis of 4-6 months, compared to other physicians with less positive attitudes toward hospice.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Chinn: Although physicians who would strongly agree to hospice themselves if terminally ill were more likely to have timely discussions about hospice with their cancer patients compared to other physicians, less than 30% did so.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Chinn: While end-of-life care discussions with terminally ill cancer patients can be difficult, initiating them early on may increase patient understanding about prognosis, clarify the extent to which treatment can help, demystify what hospice is and can offer, and best help patients maintain a high quality of life that is consistent with their values. For physicians with less positive attitudes toward hospice, education on the benefits of how hospice can help their patients may increase rates of timely end-of-life care discussions. For instance, palliative care rotations for medical students and residents may help.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Chinn: Further research should address the extent to which other factors might act as barriers to timely end-of-life care discussions.
Chinn GM, Liu P, Klabunde CN, Kahn KL, Keating NL. Physicians’ Preferences for Hospice if They Were Terminally Ill and the Timing of Hospice Discussions With Their Patients. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.12825.