Originally published as JCO Early Release 10.1200/JCO.2008.17.8079 on December 29 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Casarett, D. J. Articles by Asch, D. A. Search for Related Content PubMed PubMed Citation Articles by Casarett, D. J. Articles by Asch, D. A. Social Bookmarking                            What's this?

The Terrible Choice: Re-Evaluating Hospice Eligibility Criteria for Cancer

From the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center; Leonard Davis Institute of Health Economics; and University of Pennsylvania Schools of Medicine and Nursing, Philadelphia, PA.

Corresponding author: David Casarett, MD, MA, University of Pennsylvania, 3615 Chestnut St, Philadelphia, PA 19104; e-mail: casarett{at}mail.med.upenn.edu.

Purpose To be eligible for the Medicare Hospice Benefit, cancer patients with a life expectancy of 6 months or less must give up curative treatment. Our goal was to determine whether willingness to make this choice identifies patients with greater need for hospice services.

Patients and Methods Three hundred patients with cancer and 171 family members were recruited from six oncology practices. Respondents completed conjoint interviews in which their perceived need for five hospice services was calculated from the choices they made among combinations of services. Patients' preferences for treatment were measured, and patients were followed for 6 months or until death.

Results Thirty-eight patients (13%) said they would not want cancer treatment even if it offered an almost 100% chance of 6-month survival. These patients, who would have been eligible for hospice, did not have greater perceived need for hospice services compared with other patients (n = 262; mean, 1.75 v 1.98; Wilcoxon rank sum test, P = .46), nor did their family members (mean, 1.95 v 2.04; Wilcoxon rank sum test, P = .80). Instead, independent predictors of patients' perceived need for hospice services included African American ethnicity, less social support, worse functional status, and a greater burden of psychological symptoms. For families, predictors included caregiver burden, worse self-reported health, working outside the home, and caring for a patient with worse functional status.

Conclusion The requirement that patients forgo life-sustaining treatment does not identify patients with greater perceived need for hospice services. Other characteristics offer a better way to identify the patients who are most likely to benefit from hospice.

Supported by Grant No. R01CA109540, the Paul Beeson Physician Faculty Scholars Award, and the Presidential Early Career Award for Scientists and Engineers (D.J.C.).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?