Which hospice patients with cancer are able to die in the setting of their choice? Results of a retrospective cohort study

Neha Jeurkar, Sue Farrington, Teresa R. Craig, Julie Slattery, Joan K. Harrold, Betty Oldanie, Joan Teno, David J. Casarett

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine which hospice patients with cancer prefer to die at home and to define factors associated with an increased likelihood of dying at home. Methods: An electronic health record-based retrospective cohort study was conducted in three hospice programs in Florida, Pennsylvania, and Wisconsin. Main measures included preferred versus actual site of death. Results: Of 7,391 patients, preferences regarding place of death were determined at admission for 5,837 (79%). After adjusting for other characteristics, patients who preferred to die at home were more likely to die at home (adjusted proportions, 56.5% v 37.0%; odds ratio [OR], 2.21; 95% CI, 1.77 to 2.76). Among those patients (n = 3,152) who preferred to die at home, in a multivariable logistic regression model, patients were more likely to die at home if they had at least one visit per day in the first 4 days of hospice care (adjusted proportions, 61% v 54%; OR, 1.23; 95% CI, 1.07 to 1.41), if they were married (63% v 54%; OR, 1.35; 95% CI, 1.10 to 1.44), and if they had an advance directive (65% v 50%; OR, 2.11; 95% CI, 1.54 to 2.65). Patients with moderate or severe pain were less likely to die at home (OR, 0.56; 95% CI, 0.45 to 0.64), as were patients with better functional status (higher Palliative Performance Scale score: < 40, 64.8%; 40 to 70, 50.2%; OR, 0.79; 95% CI, 0.67 to 0.93; > 70, 40.5%; OR, 0.53; 95% CI, 0.35 to 0.82). Conclusion: Increased hospice visit frequency may increase the likelihood of patients being able to die in the setting of their choice.

Original languageEnglish (US)
Pages (from-to)2783-2787
Number of pages5
JournalJournal of Clinical Oncology
Volume30
Issue number22
DOIs
StatePublished - Aug 1 2012
Externally publishedYes

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Hospices
Cohort Studies
Retrospective Studies
Odds Ratio
Neoplasms
Hospice Care
Logistic Models
Advance Directives
Patient Preference
Electronic Health Records
Pain

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Jeurkar, N., Farrington, S., Craig, T. R., Slattery, J., Harrold, J. K., Oldanie, B., ... Casarett, D. J. (2012). Which hospice patients with cancer are able to die in the setting of their choice? Results of a retrospective cohort study. Journal of Clinical Oncology, 30(22), 2783-2787. https://doi.org/10.1200/JCO.2011.41.5711

Which hospice patients with cancer are able to die in the setting of their choice? Results of a retrospective cohort study. / Jeurkar, Neha; Farrington, Sue; Craig, Teresa R.; Slattery, Julie; Harrold, Joan K.; Oldanie, Betty; Teno, Joan; Casarett, David J.

In: Journal of Clinical Oncology, Vol. 30, No. 22, 01.08.2012, p. 2783-2787.

Research output: Contribution to journalArticle

Jeurkar, N, Farrington, S, Craig, TR, Slattery, J, Harrold, JK, Oldanie, B, Teno, J & Casarett, DJ 2012, 'Which hospice patients with cancer are able to die in the setting of their choice? Results of a retrospective cohort study', Journal of Clinical Oncology, vol. 30, no. 22, pp. 2783-2787. https://doi.org/10.1200/JCO.2011.41.5711
Jeurkar, Neha ; Farrington, Sue ; Craig, Teresa R. ; Slattery, Julie ; Harrold, Joan K. ; Oldanie, Betty ; Teno, Joan ; Casarett, David J. / Which hospice patients with cancer are able to die in the setting of their choice? Results of a retrospective cohort study. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 22. pp. 2783-2787.
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abstract = "Purpose: To determine which hospice patients with cancer prefer to die at home and to define factors associated with an increased likelihood of dying at home. Methods: An electronic health record-based retrospective cohort study was conducted in three hospice programs in Florida, Pennsylvania, and Wisconsin. Main measures included preferred versus actual site of death. Results: Of 7,391 patients, preferences regarding place of death were determined at admission for 5,837 (79{\%}). After adjusting for other characteristics, patients who preferred to die at home were more likely to die at home (adjusted proportions, 56.5{\%} v 37.0{\%}; odds ratio [OR], 2.21; 95{\%} CI, 1.77 to 2.76). Among those patients (n = 3,152) who preferred to die at home, in a multivariable logistic regression model, patients were more likely to die at home if they had at least one visit per day in the first 4 days of hospice care (adjusted proportions, 61{\%} v 54{\%}; OR, 1.23; 95{\%} CI, 1.07 to 1.41), if they were married (63{\%} v 54{\%}; OR, 1.35; 95{\%} CI, 1.10 to 1.44), and if they had an advance directive (65{\%} v 50{\%}; OR, 2.11; 95{\%} CI, 1.54 to 2.65). Patients with moderate or severe pain were less likely to die at home (OR, 0.56; 95{\%} CI, 0.45 to 0.64), as were patients with better functional status (higher Palliative Performance Scale score: < 40, 64.8{\%}; 40 to 70, 50.2{\%}; OR, 0.79; 95{\%} CI, 0.67 to 0.93; > 70, 40.5{\%}; OR, 0.53; 95{\%} CI, 0.35 to 0.82). Conclusion: Increased hospice visit frequency may increase the likelihood of patients being able to die in the setting of their choice.",
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AU - Farrington, Sue

AU - Craig, Teresa R.

AU - Slattery, Julie

AU - Harrold, Joan K.

AU - Oldanie, Betty

AU - Teno, Joan

AU - Casarett, David J.

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N2 - Purpose: To determine which hospice patients with cancer prefer to die at home and to define factors associated with an increased likelihood of dying at home. Methods: An electronic health record-based retrospective cohort study was conducted in three hospice programs in Florida, Pennsylvania, and Wisconsin. Main measures included preferred versus actual site of death. Results: Of 7,391 patients, preferences regarding place of death were determined at admission for 5,837 (79%). After adjusting for other characteristics, patients who preferred to die at home were more likely to die at home (adjusted proportions, 56.5% v 37.0%; odds ratio [OR], 2.21; 95% CI, 1.77 to 2.76). Among those patients (n = 3,152) who preferred to die at home, in a multivariable logistic regression model, patients were more likely to die at home if they had at least one visit per day in the first 4 days of hospice care (adjusted proportions, 61% v 54%; OR, 1.23; 95% CI, 1.07 to 1.41), if they were married (63% v 54%; OR, 1.35; 95% CI, 1.10 to 1.44), and if they had an advance directive (65% v 50%; OR, 2.11; 95% CI, 1.54 to 2.65). Patients with moderate or severe pain were less likely to die at home (OR, 0.56; 95% CI, 0.45 to 0.64), as were patients with better functional status (higher Palliative Performance Scale score: < 40, 64.8%; 40 to 70, 50.2%; OR, 0.79; 95% CI, 0.67 to 0.93; > 70, 40.5%; OR, 0.53; 95% CI, 0.35 to 0.82). Conclusion: Increased hospice visit frequency may increase the likelihood of patients being able to die in the setting of their choice.

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