Families of patients dying with lung or colorectal cancer judged end-of-life care as better when it was less aggressive, involved earlier hospice, avoided intensive care unit (ICU) admission, and included death outside of the hospital, according to a study reported by Wright et al in JAMA.
The study involved interviews with 1,146 family members of 1,146 Medicare patients with advanced lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance study who died by the end of 2011. Interviews occurred at a median of 145 days after death. Patients had a median age of 76 years, and 56% were male.
Factors in ‘Excellent’ Care
Overall, family members reported that end-of-life care was excellent for 51.3% of cases; very good for 27.8%; and good, fair, or poor for 20.9%. Care was reported as excellent in a higher proportion of patients who received hospice care of more than 3 days (58.8%, 352 of 599) vs those receiving no or ≤ 3 days of hospice care (43.1%, 236 of 547; adjusted difference = 16.5%, 95% confidence interval [CI] = 10.7%–22.4%). Care was reported as excellent less frequently for patients admitted to the ICU within 30 days of death (45.0%, 68 of 151) vs those not admitted to the ICU within 30 days of death (52.3%, 520 of 995; adjusted difference = −9.4%, 95% CI = −18.2% to −0.6%). Care was reported as excellent less frequently for patients dying in the hospital (42.2%, 194 of 460) vs those not dying in the hospital (57.4%, 394 of 686; adjusted difference = −17.0%, 95% CI = −22.9% to −11.1%).
Death in their preferred location was less common for patients who received no or ≤ 3 days of hospice care (40.0%, 152 of 380) than for those who received more than 3 days of hospice care (72.8%, 287 of 394; adjusted difference = −34.4%, 95% CI = −41.7% to −27.0%).
The investigators concluded: “Among family members of older patients with fee-for service Medicare who died of lung or colorectal cancer, earlier hospice enrollment, avoidance of ICU admissions within 30 days of death, and death occurring outside the hospital were associated with perceptions of better end-of-life care. These findings are supportive of advance care planning consistent with the preferences of patients.”
The study was supported by the National Cancer Institute and the Cancer Care Outcomes Research and Surveillance Consortium.
Alexi A. Wright, MD, MPH, of Dana-Farber Cancer Institute, is the corresponding author of the JAMA article.
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