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NLM Director’s Comments Transcript
Hospice Advantages: 01/12/2015
Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff U.S. National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
While a pioneering study reports hospice care for very ill cancer patients comparatively lowered some key medical indicators and costs, an accompanying editorial in the Journal of the American Medical Associationsuggests more research is needed to demonstrate the advantages of hospice or non-hospice care for many end-of-life-patients.
The national study of 18,165 pairs of Medicare beneficiaries with a poor cancer prognosis suggested seniors who received hospice care had fewer hospitalization rates, intensive care admissions, invasive procedures, and lower medical costs compared to peers who received non-hospice care.
Specifically, about 42 percent of the seniors (with a poor cancer prognosis) in hospice were hospitalized compared to 65 percent of the participants who continued with non-hospice care.
About 15 percent of seniors in hospice were hospitalized for intensive care compared to 36 percent of the participants who continued with non-hospice care.
About 27 percent of seniors in hospice received intensive care compared to 51 percent of the participants who continued with non-hospice care.
The mean care costs for the last year of life were $62,819 for seniors in hospice (with a poor cancer prognosis) compared to $71,517 for the participants who continued with traditional care.
The study’s six authors write (and we quote): ‘While enrolled in hospice, beneficiaries were hospitalized less, received less intensive care, underwent fewer procedures, and were less likely to die in hospitals and cared nursing facilities’ (end of quote).
While the study’s authors note all the comparative differences between hospice and non-hospice cancer patients are statistically significant, an accompanying editorial suggests more evidence is needed to help physicians, families, and caregivers make hospice decisions.
The editorial’s two authors explain (and we quote): ‘The pressing policy issue in the United States does not involve only patients dying of poor-prognosis cancers, but patients with non-cancer chronic illness for whom the costs of prolonged hospice stays exceed the potential savings from hospitalizations’ (end of quote).
While the editorial’s authors acknowledge assessing issues such as cost savings, hospitalization rates, intensive care admission, and invasive procedures represent important steps in assessing the merits of hospice versus non-hospice care, they add additional measures of end-of-life quality of care are needed.
The editorial’s authors conclude additional measures of quality of care coupled with new comparative data about other diseases and conditions could create a more transparent and accountable evidence base to assist those making hospice decisions.
Meanwhile, MedlinePlus.gov’s hospice care health topic page explains hospice is end-of-life care that is provided by a team of physicians and volunteers who provide medical, psychological, and spiritual support. MedlinePlus.gov’s hospice care health topic page adds these caregivers try to control pain and other symptoms so a patient can be as comfortable as possible.
A website from the Mayo Foundation for Medical Education and Research counsels how to make hospice and end-of-life decisions in the ‘overviews’ section of MedlinePlus.gov’s hospice care health topic page. Another website from the Mayo Foundation for Medical Education and Research provides specific end-of-life caregiving advice in the ‘coping’ section of MedlinePlus.gov’s hospice care health topic page.
MedlinePlus.gov’s hospice care health topic page additionally provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about hospice care as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s hospice care health topic page type ‘hospice care’ in the search box on MedlinePlus.gov’s home page, then, click on ‘Hospice care (National Library of Medicine).’ MedlinePlus.gov also has a health topic page devoted to end of life issues.
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