Discussions with physicians about hospice among patients with metastatic lung cancer

Haiden A. Huskamp, Nancy L. Keating, Jennifer L. Malin, Alan M. Zaslavsky, Jane C. Weeks, Craig C. Earle, Joan Teno, Beth A. Virnig, Katherine L. Kahn, Yulei He, John Z. Ayanian

Research output: Contribution to journalArticle

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Abstract

Background: Many terminally ill patients enroll in hospice only in the final days before death or not at all. Discussing hospice with a health care provider could increase awareness of hospice and possibly result in earlier use. Methods: We used data on 1517 patients diagnosed as having stage IV lung cancer from a multiregional study. We estimated logistic regression models for the probability that a patient discussed hospice with a physician or other health care provider before an interview 4 to 7 months after diagnosis as reported by either the patient or surrogate or documented in the medical record. Results: Half (53%) of the patients had discussed hospice with a provider. Patients who were black, Hispanic, non-English speaking, married or living with a partner, Medicaid beneficiaries, or had received chemotherapy were less likely to have discussed hospice. Only 53% of individuals who died within 2 months after the interview had discussed hospice, and rates were lower among those who lived longer. Patients who reported that they expected to live less than 2 years had much higher rates of discussion than those expecting to live longer. Patients reporting the most severe pain or dyspnea were no more likely to have discussed hospice than those reporting less severe or no symptoms. A third of patients who reported discussing do-not-resuscitate preferences with a physician had also discussed hospice. Conclusions: Many patients diagnosed as having metastatic lung cancer had not discussed hospice with a provider within 4 to 7 months after diagnosis. Increased communication with physicians could address patients' lack of awareness about hospice and misunderstandings about prognosis.

Original languageEnglish (US)
Pages (from-to)954-962
Number of pages9
JournalArchives of Internal Medicine
Volume169
Issue number10
DOIs
StatePublished - May 25 2009
Externally publishedYes

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Hospices
Lung Neoplasms
Physicians
Health Personnel
Logistic Models
Interviews
Terminally Ill
Medicaid
Hispanic Americans
Dyspnea
Medical Records
Communication

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Huskamp, H. A., Keating, N. L., Malin, J. L., Zaslavsky, A. M., Weeks, J. C., Earle, C. C., ... Ayanian, J. Z. (2009). Discussions with physicians about hospice among patients with metastatic lung cancer. Archives of Internal Medicine, 169(10), 954-962. https://doi.org/10.1001/archinternmed.2009.127

Discussions with physicians about hospice among patients with metastatic lung cancer. / Huskamp, Haiden A.; Keating, Nancy L.; Malin, Jennifer L.; Zaslavsky, Alan M.; Weeks, Jane C.; Earle, Craig C.; Teno, Joan; Virnig, Beth A.; Kahn, Katherine L.; He, Yulei; Ayanian, John Z.

In: Archives of Internal Medicine, Vol. 169, No. 10, 25.05.2009, p. 954-962.

Research output: Contribution to journalArticle

Huskamp, HA, Keating, NL, Malin, JL, Zaslavsky, AM, Weeks, JC, Earle, CC, Teno, J, Virnig, BA, Kahn, KL, He, Y & Ayanian, JZ 2009, 'Discussions with physicians about hospice among patients with metastatic lung cancer', Archives of Internal Medicine, vol. 169, no. 10, pp. 954-962. https://doi.org/10.1001/archinternmed.2009.127
Huskamp HA, Keating NL, Malin JL, Zaslavsky AM, Weeks JC, Earle CC et al. Discussions with physicians about hospice among patients with metastatic lung cancer. Archives of Internal Medicine. 2009 May 25;169(10):954-962. https://doi.org/10.1001/archinternmed.2009.127
Huskamp, Haiden A. ; Keating, Nancy L. ; Malin, Jennifer L. ; Zaslavsky, Alan M. ; Weeks, Jane C. ; Earle, Craig C. ; Teno, Joan ; Virnig, Beth A. ; Kahn, Katherine L. ; He, Yulei ; Ayanian, John Z. / Discussions with physicians about hospice among patients with metastatic lung cancer. In: Archives of Internal Medicine. 2009 ; Vol. 169, No. 10. pp. 954-962.
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abstract = "Background: Many terminally ill patients enroll in hospice only in the final days before death or not at all. Discussing hospice with a health care provider could increase awareness of hospice and possibly result in earlier use. Methods: We used data on 1517 patients diagnosed as having stage IV lung cancer from a multiregional study. We estimated logistic regression models for the probability that a patient discussed hospice with a physician or other health care provider before an interview 4 to 7 months after diagnosis as reported by either the patient or surrogate or documented in the medical record. Results: Half (53{\%}) of the patients had discussed hospice with a provider. Patients who were black, Hispanic, non-English speaking, married or living with a partner, Medicaid beneficiaries, or had received chemotherapy were less likely to have discussed hospice. Only 53{\%} of individuals who died within 2 months after the interview had discussed hospice, and rates were lower among those who lived longer. Patients who reported that they expected to live less than 2 years had much higher rates of discussion than those expecting to live longer. Patients reporting the most severe pain or dyspnea were no more likely to have discussed hospice than those reporting less severe or no symptoms. A third of patients who reported discussing do-not-resuscitate preferences with a physician had also discussed hospice. Conclusions: Many patients diagnosed as having metastatic lung cancer had not discussed hospice with a provider within 4 to 7 months after diagnosis. Increased communication with physicians could address patients' lack of awareness about hospice and misunderstandings about prognosis.",
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AU - Earle, Craig C.

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