US- Hospice referrals occuring too close to end of life

Categories: Care.

According to a Journal of the American Medical Association study from February 2013, hospice care is now part of standard medical care in the US with hospice use doubling between 2000 and 2009.

These statistics do no paint a full picture however. The study has also found that there were more repeat hospitalizations and an increase from 10.3% to 14.2% of transfers of patients from hospital to another health care setting in the last three days of life. Furthermore, 28.4% only used the hospice for three days or less, and 40.3% were in an ICU immediately beforehand.

Joan Teno, the main author of the JAMA study, said: “For many patients, hospice is an ‘add-on’ to a very aggressive pattern of care during the last days of life. I suspect this is not what patients want.”

“With this pattern of going from the ICU to hospice, these dying patients are getting symptom control late and can’t benefit as much from the psychosocial supports available were there a longer hospice stay.”

The concern is that conversations about avoiding ICU care and moving into hospice and palliative care are occurring too late. According to Joan Teno, this is partly because of the fact that hospitals are not incentivised to have these conversations at the right time. She recommends that the government reform the way that the healthcare system is structured. 

More information can be found on the CNN and Brown University websites, and the study can be downloaded from the JAMA website.