Hospice care under-used by many terminally ill patients

May 25 2009

Hospice, a well-established approach to palliative care, has enabled countless people worldwide to die with dignity. Through focusing on the patient rather than the disease, individuals can spend the last weeks of their lives in an environment where hospice caregivers minimize their pain, maximize their comfort, and provide bereavement services for loved ones and family members.

A new study led by researchers at Harvard Medical School, however, found that only about half the patients diagnosed with metastatic lung cancer discuss hospice with their physician within 4 to 7 months of their diagnosis.

"Many terminally-ill patients who might benefit from hospice aren't discussing it with their physicians and may not be aware of the services hospice could offer," says Haiden Huskamp, lead author on the study and HMS associate professor of health care policy. Findings were published in the May 25 Archives of Internal Medicine.

Through the Cancer Care Outcomes Research and Surveillance Consortium, the researchers surveyed 1,517 patients diagnosed with metastatic lung cancer. For reasons not clear, blacks and Hispanics were less likely to discuss hospice than whites and Asians. Forty-nine percent of blacks and 43 percent of Hispanics discussed hospice with their doctors; for whites and Asians the percentages were 53 and 57, respectively. Married people were also less likely than unmarried people to have this discussion (51 percent compared with 57 percent, respectively).

In general, the longer patients expected to live after their diagnosis, the less likely they were to have explored hospice care with their doctor. However, the researchers also found that patients tended to overestimate how long they had to live. For example, about 30 percent of the patients thought that they would live up to two years. In reality though, only about 6 percent of patients with metastatic lung cancer will survive that long.

What's more, patients who preferred care that eased their pain and suffering at the end of life over care that extended life (roughly 50 percent of patients) were no more likely to have discussed hospice than patients who had the opposite preference.

"These conversations can be difficult for everyone involved-patients, families, and physicians," says Huskamp. "But discussing prognosis and end-of-life care options in advance is essential to make sure that patients receive care that reflects their wishes."

"Patients with advanced lung cancer understandably hope that cancer treatments can extend their lives," notes John Ayanian, senior author on the study and HMS professor of medicine and health care policy. "When these treatments are no longer working, their doctors have an important role to play in offering them hospice care that will ease their symptoms as they approach the end of life."