Patients who stop hospice are also far more likely to end up needing emergency department care, ICU care and to be hospitalized. The study is published in the October 1 issue of the Journal of Clinical Oncology.
“This is particularly important given the latest evidence that patients who die in ICUs and hospitals experience far more physical and emotional distress than patients who die at home with hospice,” said Elizabeth H. Bradley, professor of public health at Yale and the paper’s senior author. “For decades, we have seen better outcomes for patients and families who use hospice, but here we also find clear evidence that leaving hospice is also costly financially.”
The research team evaluated data from 90,826 patients with cancer who were served by 1,384 hospices between 1998 and 2002. They found that nearly 11 percent of the patients who stopped hospice care had considerably higher health care use and costs than those who remained with hospice until death.
The researchers found that 33.9 percent of the patients who opted out of hospice wound up being admitted to an emergency department, compare to only 3.1 percent of those who remained in hospice care until death. Additionally, 39.8 percent of former hospice patients were admitted to the hospital as inpatients, but only 1.6 percent of enrolled patients were. Former hospice patients also spent an average of 19.3 days in the hospital, whereas patients who continued with hospice spent an average of 6.7 days.
Patients who stayed with hospice incurred $6,537 in expenses from the time of hospice enrollment to death, while those who stopped hospice care incurred $30,848 in expenses. The Medicare expenditures that the researchers evaluated included hospice care, hospitalizations, physician visits, outpatient care, medical equipment and supplies and home health care services.
For cancer patients who stop hospice, the study recommend that oncologists connect with palliative care teams where available and try to ensure that the patient and their family continue to receive support.
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