The Debate in Hospice Care

doi:10.1200/jop.0838503

Cited by 14 publications

(2 citation statements)

References 21 publications

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“…Concurrent disease-directed therapy with hospice care is not novel. Even under the current hospice payment policy, some US hospices have open-access policies, which allow people who may or may not be clinically eligible for the Medicare Hospice Benefit to receive the hospice’s services while concurrently receiving treatments that are disease directed, including those designed to palliate symptoms and improve quality of life; costs for these services are usually absorbed by hospices …”

Section: Concurrent Care In Practicementioning

confidence: 99%

Concurrent Care as the Next Frontier in End-of-Life Care

Ernecoff,

Anhang Price

2023

JAMA Health Forum

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ImportanceHospice care is a unique type of medical care for people near the end of life and their families, with an emphasis on providing physical and psychological symptom management, spiritual care, and family caregiver support to promote quality of life. However, many people in the US who could benefit from hospice have very short stays or do not enroll at all due to current hospice policy. Changing policy to allow for concurrent availability of disease-directed therapy and hospice care—known as concurrent care—offers an opportunity to increase hospice use and lengths of stay.ObservationsUnder Medicare payment policy, hospices are responsible for covering all costs related to patients’ terminal conditions under a per diem rate. This payment structure has led to a de facto requirement that patients forgo costly therapies (including life-prolonging treatments or those with palliative intent) on enrollment in hospice because they are prohibitively expensive. In other countries, in Medicaid for children, and in the Veterans Health Administration in the US, there is greater flexibility in providing hospice services alongside life-prolonging care. Often paired with innovative payment models, concurrent care smooths practical, psychological, and physical care transitions when patient goals prioritize comfort. For example, allowing simultaneous receipt of hospice care and dialysis for people living with end-stage kidney disease—a group with relatively low hospice enrollment—can act as a bridge to hospice and potentially promote longer lengths of stay.Conclusions and RelevanceMedicare and health care delivery systems are increasingly testing payment and care delivery models to improve hospice use via concurrent care, offering an important opportunity for innovation to better meet the needs of people living with serious illness and their families.

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Section: Concurrent Care In Practicementioning

confidence: 99%

Concurrent Care as the Next Frontier in End-of-Life Care

Ernecoff,

Anhang Price

2023

JAMA Health Forum

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“…Thus, patients with cancer cannot receive radiotherapy or chemotherapy, such as single-fraction radiotherapy for painful bone metastasis, for palliative purposes. To alleviate this constraint, some hospices have developed open-access programs that allow patients to receive care for their terminal conditions . These hospices, however, encounter an increase in costs without an accompanying increase in reimbursement.…”

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confidence: 99%

Trends in Provision of Palliative Radiotherapy and Chemotherapy Among Hospices in the United States, 2011-2018

Hsu

Wang

2020

JAMA Oncol

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phase-in (months 15-21), and postimplementation (months 22-36). We excluded the phase-in from the main analysis. Covariates included age, sex, race, ethnicity, tumor type, and a monthly time trend.We estimated the average marginal effect of each exposure as of December 2018 as the absolute percentage-point difference between preimplementation and postimplementation predicted probabilities of zoledronate prescription. An interaction between nudge exposure and study phase facilitated comparisons of each nudge's marginal effect vs control. All tests were 2-sided with an α of 0.025 (corrected for 2 comparisons), using Stata statistical software (version 16, StataCorp).| Across 7 practice sites, 220 clinicians prescribed 14 701 zoledronate or denosumab prescriptions to 2595 patients (1926 [74.2%] women) with breast (1528 [58.9%]), lung (730 [28.1%]), or prostate (337 [13.0%]) cancer. The mean (SD) age was 62.7 (12.3), 67.0 (12.7), and 66.8 (11.9) years at sites A, B, and other, respectively.The Figure shows unadjusted trends in monthly zoledronate prescription by nudge exposure. As of December 2018, nudges were associated with statistically significant increases in the probability of zoledronate prescription compared with the control: site A, 26.0 percentage-point increase (95% CI, 18.5-33.4; P < .001 with leadership endorsement and performance feedback), and site B, 44.9 percentage-point increase (95% CI, 18.5-71.4; P = .001 with additionally accountable justification) (Table ). Results were robust to exclusion of clinicians practicing at multiple sites (n = 22).

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Palliative Care in Lung Cancer

Shinde

Dashti

2016

Cancer Treatment and Research

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Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung cancer is very high and has a negative impact on their quality of life (QOL). Palliative care with its focus on the management of symptoms and addressing physical, psychosocial, spiritual, and existential suffering, as well as medically appropriate goal setting and open communication with patients and families, significantly adds to the quality of care received by advanced lung cancer patients. The Provisional Clinical Opinion (PCO) of American Society of Clinical Oncology (ASCO) as well as the National Cancer Care Network's (NCCN) clinical practice guidelines recommends early integration of palliative care into routine cancer care. In this chapter, we will provide an overview of palliative care in lung cancer and will examine the evidence and recommendations with regard to a comprehensive and interdisciplinary approach to symptom management, as well as discussions of goals of care, advance care planning, and care preferences.

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The Debate in Hospice Care

Cited by 14 publications

References 21 publications

Concurrent Care as the Next Frontier in End-of-Life Care

Concurrent Care as the Next Frontier in End-of-Life Care

Trends in Provision of Palliative Radiotherapy and Chemotherapy Among Hospices in the United States, 2011-2018

Palliative Care in Lung Cancer

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