Hospice Care for Heart Failure: Challenges Faced by Hospice Staff in a Predominantly Rural Setting

Warraich, Haider J.; Taylor, Donald H.; Casarett, David; Hasan, Marisette; Patel, Chetan B.; Kamal, Arif H.; Harker, Matthew; Mentz, Robert J.

doi:10.1089/jpm.2018.0454

Cited by 7 publications

(5 citation statements)

References 2 publications

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“…Symptom benefit may contribute to a greater acceptance of hospitalization during EOL 33,34 . There is also evidence that patients with HF may be more willing to accept hospitalization in order to live longer 35–37 . Although patients’ preferences are an important factor, a recent study showed that patients with HF were more likely than cancer patients to receive care inconsistent with stated wishes 38 .…”

Section: Discussionmentioning

confidence: 99%

“…33,34 There is also evidence that patients with HF may be more willing to accept hospitalization in order to live longer. [35][36][37] Although patients' preferences are an important factor, a recent study showed that patients with HF were more likely than cancer patients to receive care inconsistent with stated wishes. 38 In addition, increased prognostic uncertainty in HF may create challenges in identifying when a patient is entering EOL, resulting in increased utilization.…”

Section: Discussionmentioning

confidence: 99%

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Rural disparities in end‐of‐life care for patients with heart failure: Are they due to geography or socioeconomic disparity?

Hutchinson

Han

Lucas

et al. 2021

The Journal of Rural Health

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Purpose The impact of rurality and socioeconomic deprivation on end‐of‐life (EOL) care for patients with heart failure (HF) is unknown. We analyzed claims to describe the prevalence and predictors of EOL health care utilization for patients dying with HF in a predominantly rural state. Methods We used the MaineHealth Data Organization's All‐Payer Claims Data to identify 15,168 patients ≥35 who died with HF between 2012 and 2017. The primary outcome was health care utilization during the last 180 days of life (EOL definition for this analysis), including emergency department (ED) visits, hospitalizations, intensive care unit (ICU) admissions, and hospice utilization. Patient characteristics analyzed included age, gender, comorbidities, area deprivation index (ADI), and rurality. Findings Among 15,168 patients ≥35 who died with HF, 48% had ≥2 hospitalizations, 72% had ≥2 ED visit, 29% had an ICU stay, 2% initiated dialysis during EOL, and 64% received hospice. Rural patients were more likely to have an ICU admission and have ≥2 hospitalizations. Patients residing in areas with higher ADI were more likely to be hospitalized, admitted to the ICU, and started on dialysis. Both rural patients and those living in higher ADI areas were less likely to receive hospice. After multivariable adjustment, rurality and ADI were independently associated with a decreased likelihood of receiving hospice (OR 0.62 [95% CI: 0.53‐0.72] for the most rural patients and OR 0.64 [95% CI: 0.57‐0.72] for the highest ADI). Conclusion Both rurality and local area deprivation drive disparities in EOL care for patients dying with heart failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rural disparities in end‐of‐life care for patients with heart failure: Are they due to geography or socioeconomic disparity?

Hutchinson

Han

Lucas

et al. 2021

The Journal of Rural Health

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“…A study of hospice staff in North and South Carolina in the US found that most staff lacked experience and were uncomfortable when using inotropes, mainly because their hospice did not provide coverage of inotropes. [92] In a focus group of HF palliative care specialist nurses in Scotland and England, junior nurses reported their reluctance to accept patients with HF for hospice care and some hospices needed reassurance about their ability to meet the needs of patients with HF. [93]…”

Section: Contributing Factors To Hospice Underuse In People With Hearmentioning

confidence: 99%

Hospice Use Among Patients with Heart Failure

et al. 2019

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“…Of concern for collaborating health professionals, consumers and policy makers is how well rural GPs are providing palliative and EOL care, and what can be done to maximise the effectiveness of their care for people at the EOL and their informal carers in Australia (Ding, Saunders, Cook, & Johnson, 2019) and other countries (Chukwusa et al., 2019; Conlon et al., 2019; Isaacson & Lynch, 2017; Leng, Jing, Nicholas, & Wang, 2019; Warraich et al., 2019). Prior to the development of interventions to support GPs and consumers, it is necessary to identify the attributes of EOL care and current gaps in service delivery within rural settings.…”

Section: Introductionmentioning

confidence: 99%

End‐of‐life care in rural and regional Australia: Patients’, carers’ and general practitioners’ expectations of the role of general practice, and the degree to which they were met

Johnson

Senior

McVey

et al. 2020

Health Soc Care Community

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Various cancers, including of the lung, stomach, liver, breast, colon and rectum, remain among the top 10 leading causes of death in upper-middle-income and high-income countries (World Health Organization, 2018a). Latest statistical information indicates that there were approximately 18.1 million new cancer cases and 9.6 million cancer-related deaths worldwide in 2018 (Ferlay et al., 2019). Currently cancer is responsible for 30% of all deaths in Australia (Australian Institute of Health & Welfare, 2018). With an increasingly ageing population, the number of people dying with cancer in Australia is expected to increase by approximately 25% in the next decade, from 44,108 deaths in 2013 to an estimated 55,714 deaths in 2025 (Australian Institute of Health & Welfare, 2016). This increase in cancer deaths will produce a range of health challenges, including a rise in the demand for medical and support services and for high-quality end-of-life (EOL) (the last 6-12 months of life) care options. Providing the best care at EOL has been identified as a health priority in Australia (Palliative Care Australia (PCA), 2018). Policy makers have highlighted the need to build the capacity and competence of primary healthcare services to provide support for people at the end of life and the need to improve access to more

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Hospice Care for Heart Failure: Challenges Faced by Hospice Staff in a Predominantly Rural Setting

Cited by 7 publications

References 2 publications

Rural disparities in end‐of‐life care for patients with heart failure: Are they due to geography or socioeconomic disparity?

Rural disparities in end‐of‐life care for patients with heart failure: Are they due to geography or socioeconomic disparity?

Hospice Use Among Patients with Heart Failure

End‐of‐life care in rural and regional Australia: Patients’, carers’ and general practitioners’ expectations of the role of general practice, and the degree to which they were met

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