Hospice Care May Decrease Depression in Surviving Spouses

Katherine Ornstein, PhD MPH Assistant Professor Brookdale Department of Geriatrics and Palliative Medicine Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place, Box 1070 New York, NY 10029MedicalResearch.co Interview with:
Katherine Ornstein, PhD MPH
Assistant Professor
Brookdale Department of Geriatrics and Palliative Medicine
Institute for Translational Epidemiology
Icahn School of Medicine at Mount Sinai
New York, NY 10029

Medical Research: What is the background for this study? What are the main findings?

Dr. Ornstein: There is an increased focus on the need to support caregivers and families, particularly at the End of Life (EOL). They play a critical role in the care process and decision making, yet this can be a very high stress role with an increased risk for negative consequences. Hospice services, which are increasing, are focused on palliative rather than curative care and include medical services, symptom management, spiritual counseling, social services and bereavement counseling delivered by an interdisciplinary team of professionals for dying patients.  An important part of the hospice service is the provision of support to families during illness and after death.  Prior research suggests that hospice (which is cost saving, has benefits to patients), may also  be beneficial to families. Yet these studies have been largely limited to patients with cancer, have failed to adequately control for differences between patients who do or do not use hospice.

Overall, there was an increase in depressive symptoms after death.  However, surviving spouses of those who used hospice were more likely to have a decrease in depressive symptoms. We found that the positive benefit of hospice was much stronger when we looked at least 1 year after death.

Medical Research: What should clinicians and patients take away from your report?

Dr. Ornstein: Hospice provides benefits for caregivers. Given that hospice is an existing comprehensive care package that helps patients and achieves cost savings any improvements in health for spouses is an added benefit. We should continue to maximize the use of hospice for appropriate patients —  it is a high value intervention that can benefit both the patients and their families.

But we also need to do more within hospice to support families. The majority of surviving spouses regardless of decedent’s hospice use had increased depressive symptoms after death,—-additional supports are needed if the increased depressive symptoms associated with death of spouse are to be substantially reduced. Attention to the quality of caregiver support and bereavement services within hospice will be necessary to increase its benefits for families.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Ornstein: Our findings suggest that researchers and policy makers need to start considering the downstream effects of end of life  care on families. The impact of health care services may go beyond their influence on the individual patient and additionally impact family caregivers’ own health, healthcare decisions, and future healthcare utilization. While there has been significant attention to the current unsustainable level of spending on healthcare for seriously ill persons in the U.S., or the top 5% fueling U.S. medical spending, these analyses do not even begin to factor in the downstream effects of caregiving for a seriously ill relative on spouses and other family members.

Furthermore, it is important to see which component of hospice, which is a comprehensive intervention,  is most beneficial for families.  Symptom burden may be very important, satisfaction with care overall.  Other factors such as out of pocket expenses may also play an important role and should be further investigated.

Citation:

Ornstein KA, Aldridge MD, Garrido MM, Gorges R, Meier DE, Kelley AS. Association Between Hospice Use and Depressive Symptoms in Surviving Spouses. JAMA Intern Med. Published online May 26, 2015. doi:10.1001/jamainternmed.2015.1722.

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MedicalResearch.co Interview with: Katherine Ornstein, PhD MPH (2015). Hospice Care May Decrease Depression in Caregivers