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Hospice referral rates increase
with intervention improving communication
Newswise — A simple information and
communication intervention between a patient
and physician can increase hospice referral
rates among nursing home residents, increase
their families’ ratings of end-of-life care,
and may decrease use of acute care
resources, according to an article in the
July 13 issue of JAMA.
“At least one in four Americans dies in a
nursing home, and considerable evidence
indicates that nursing home residents do not
receive optimal end-of-life care,”
background information in the article
states.
Approximately 25 percent of residents with
daily cancer pain receive no pain
medications, and residents are often
transferred to an acute care setting to
receive aggressive treatment in the last
weeks of life.
Families often express dissatisfaction with
the end-of-life care their relative receives
in nursing homes.
Nursing home residents receiving hospice
care are more likely to receive better pain
management, have their pain assessed and
have lower rates of inappropriate
medications and physical restraint use.
Despite its benefits, however, only one in
four nursing home residents enrolls in
hospice care before death.
David Casarett, M.D., M.A., from the
Philadelphia Veterans Affairs Medical
Center, Philadelphia, and colleagues
conducted a randomized trial of nursing home
residents and their decision makers to
determine whether promoting communication
about hospice would increase hospice
enrollment and improve the quality of
end-of-life treatment.
For the intervention, the researchers
interviewed residents and/or their surrogate
decision-makers to identify those whose
goals and needs for care, and treatment
preferences made them appropriate for
hospice.
The physicians of residents classified as
appropriate for hospice were notified and
asked to authorize a hospice informational
visit.
The trial was conducted from December 2003
to December 2004. Residents were followed up
for six months or until death.
One-hundred seven of the 205 residents in
the study were randomly assigned to receive
the intervention, and 98 received usual
care.
Those in the intervention group were more
likely than usual care residents to enroll
in hospice within 30 days (20 percent vs. 1
percent) and to enroll in hospice during the
follow-up period (25 percent vs. 6 percent).
Intervention residents received more hospice
care than usual care residents (average: 64
vs. 14 days), although intervention
residents were not more likely to be
enrolled in hospice at the time of their
death (36 percent vs. 38 percent).
These intervention residents had fewer acute
care admissions and spent fewer days in the
acute care setting. Families of intervention
residents rated the resident’s care more
highly than the families of usual care
residents did (on a 1-5 scale, average: 4.1
vs. 2.5).
“The results reported herein show that a
simple communication intervention can
improve the quality of end-of-life care and
decrease resource utilization by promoting
earlier access to hospice care in nursing
homes,” the authors write.
“If there is a surprise in these findings,
it is that such a simple, inexpensive, and
easily exportable intervention can
contribute so much to improving care. As
Americans spend more time in nursing homes
near the end of life, it will becomes
increasingly important to emphasize simple,
low-cost interventions like this one that
can help to ensure that residents and their
families have access to the best possible
quality of care.”
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