TY - JOUR
T1 - Intersection of Palliative Care and Hospice Use Among Patients With Advanced Lung Cancer
AU - Hooker, Elizabeth R.
AU - Chapa, Joaquin
AU - Vranas, Kelly C.
AU - Niederhausen, Meike
AU - Goodlin, Sarah J.
AU - Slatore, Christopher G.
AU - Sullivan, Donald R.
N1 - Publisher Copyright:
© Mary Ann Liebert, Inc.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Background: Hospice and palliative care (PC) are important components of lung cancer care and independently provide benefits to patients and their families. Objective: To better understand the relationship between hospice and PC and factors that influence this relationship. Methods: A retrospective cohort study of patients diagnosed with advanced lung cancer (stage IIIB/IV) within the U.S. Veterans Health Administration (VA) from 2007 to 2013 with follow-up through 2017 (n = 22,907). Mixed logistic regression models with a random effect for site, adjustment for patient variables, and propensity score weighting were used to examine whether the association between PC and hospice use varied by U.S. region and PC team characteristics. Results: Overall, 57% of patients with lung cancer received PC, 69% received hospice, and 16% received neither. Of those who received hospice, 60% were already enrolled in PC. Patients who received PC had higher odds of hospice enrollment than patients who did not receive PC (adjusted odds ratio = 3.25, 95% confidence interval: 2.43–4.36). There were regional differences among patients who received PC; the predicted probability of hospice enrollment was 85% and 73% in the Southeast and Northeast, respectively. PC team and facility characteristics influenced hospice use in addition to PC; teams with the shortest duration of existence, with formal team training, and at lower hospital complexity were more likely to use hospice (all p < 0.05). Conclusions: Among patients with advanced lung cancer, PC was associated with hospice enrollment. However, this relationship varied by geographic region, and PC team and facility characteristics. Our findings suggest that regional PC resource availability may contribute to substitution effects between PC and hospice for end-of-life care.
AB - Background: Hospice and palliative care (PC) are important components of lung cancer care and independently provide benefits to patients and their families. Objective: To better understand the relationship between hospice and PC and factors that influence this relationship. Methods: A retrospective cohort study of patients diagnosed with advanced lung cancer (stage IIIB/IV) within the U.S. Veterans Health Administration (VA) from 2007 to 2013 with follow-up through 2017 (n = 22,907). Mixed logistic regression models with a random effect for site, adjustment for patient variables, and propensity score weighting were used to examine whether the association between PC and hospice use varied by U.S. region and PC team characteristics. Results: Overall, 57% of patients with lung cancer received PC, 69% received hospice, and 16% received neither. Of those who received hospice, 60% were already enrolled in PC. Patients who received PC had higher odds of hospice enrollment than patients who did not receive PC (adjusted odds ratio = 3.25, 95% confidence interval: 2.43–4.36). There were regional differences among patients who received PC; the predicted probability of hospice enrollment was 85% and 73% in the Southeast and Northeast, respectively. PC team and facility characteristics influenced hospice use in addition to PC; teams with the shortest duration of existence, with formal team training, and at lower hospital complexity were more likely to use hospice (all p < 0.05). Conclusions: Among patients with advanced lung cancer, PC was associated with hospice enrollment. However, this relationship varied by geographic region, and PC team and facility characteristics. Our findings suggest that regional PC resource availability may contribute to substitution effects between PC and hospice for end-of-life care.
KW - delivery models
KW - end of life
KW - health services research
KW - lung neoplasms
KW - palliative care
KW - patterns of care
KW - quality of life
UR - http://www.scopus.com/inward/record.url?scp=85176964625&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85176964625&partnerID=8YFLogxK
U2 - 10.1089/jpm.2023.0040
DO - 10.1089/jpm.2023.0040
M3 - Article
C2 - 37262128
AN - SCOPUS:85176964625
SN - 1096-6218
VL - 26
SP - 1474
EP - 1481
JO - Journal of palliative medicine
JF - Journal of palliative medicine
IS - 11
ER -