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J Pain Symptom Manage. 2019 Jul;58(1):86-91. doi: 10.1016/j.jpainsymman.2019.04.006. Epub 2019 Apr 11.

Disparities in Hospice Utilization for Older Cancer Patients Living in the Deep South.

Author information

1
School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA. Electronic address: yturkman@uab.edu.
2
Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
3
University of North Texas Health Science Center, Fort Worth, Texas, USA.
4
School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
5
School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.
6
Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.
7
Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
8
School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Comprehensive Cancer Center, UAB Medicine, Birmingham, Alabama, USA.

Abstract

CONTEXT:

Hospice utilization is an end-of-life quality indicator. The Deep South has known disparities in palliative care that may affect hospice utilization.

OBJECTIVES:

The objective of this study was to evaluate the association among Deep South patient and hospital characteristics and hospice utilization.

METHODS:

This retrospective cohort study evaluated patient and hospital characteristics associated with hospice among Medicare cancer decedents aged ≥65 years in 12 southeastern cancer centers between 2012 and 2015. We examined patient-level characteristics (age, race, gender, cancer type, and received patient navigation) and hospital-level characteristics (board-certified palliative physician, inpatient palliative care beds, and hospice ownership). Outcomes included hospice (within 90 vs. three days of death). Relative risks (RRs) and 95% CIs evaluated the association between patient- and hospital-level characteristics and hospice outcomes using generalized log-linear models with Poisson distribution and robust variance estimates.

RESULTS:

Of 12,725 cancer decedents, 4142 (33%) did not utilize hospice. "No hospice" was associated with nonwhite (RR 1.24, 95% CI 1.17-1.32) and nonnavigated patients (RR 1.17, 95% CI 1.10-1.25), and those at a hospital with inpatient palliative care beds (RR 1.15, 95% CI 1.10-1.21). "Late hospice" (20%; n = 1458) was associated with being male (RR 1.31, 95% CI 1.19-1.44) and seen at a hospital without inpatient palliative care beds (RR 0.82, 95% CI 0.75-0.90).

CONCLUSIONS:

Hospice utilization differed by patient and hospital characteristics. Patients who were nonwhite, and nonnavigated, and hospitals with inpatient palliative care beds, were associated with no hospice. Research should focus on ways to improve hospice utilization in Deep South older cancer patients.

KEYWORDS:

Hospice; Medicare; South; disparities; geriatric; oncology

PMID:
30981781
PMCID:
PMC6592766
[Available on 2020-07-01]
DOI:
10.1016/j.jpainsymman.2019.04.006
[Indexed for MEDLINE]

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