Rates and risks for late referral to hospice in patients with primary malignant brain tumors. Academic Article uri icon

Overview

MeSH

  • Aged
  • Cohort Studies
  • Female
  • Home Care Services
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors

MeSH Major

  • Brain Neoplasms
  • Hospice Care
  • Referral and Consultation

abstract

  • Primary malignant brain tumors (PMBTs) are devastating malignancies with poor prognosis. Optimizing psychosocial and supportive care is critical, especially in the later stages of disease. This retrospective cohort study compared early versus late hospice enrollment of PMBT patients admitted to the home hospice program of a large urban, not-for-profit home health care agency between 2009 and 2013. Of 160 patients with PMBT followed to death in hospice care, 32 (22.5%) were enrolled within 7 days of death. When compared with patients referred to hospice more than 7 days before death, a greater proportion of those with late referral were bedbound at admission (97.2% vs 61.3%; OR=21.85; 95% CI, 3.42-919.20; P < .001), aphasic (61.1% vs 20.2%; OR = 6.13; 95% CI, 2.59-15.02; P < .001), unresponsive (38.9% vs 4%; OR = 14.76,;95% CI, 4.47-57.98; P < .001), or dyspneic (27.8% vs 9.7%; OR = 21.85; 95% CI, 3.42-10.12; P = .011). In multivariable analysis, male patients who were receiving Medicaid or charitable care and were without a health care proxy were more likely to enroll in hospice within 1 week of death. Late hospice referral in PMBT is common. PMBT patients enrolled late in hospice are severely neurologically debilitated at the time hospice is initiated and therefore may not derive optimal benefit from multidisciplinary hospice care. Men, patients with lower socioeconomic status, and those without a health care proxy may be at risk for late hospice care and may benefit from proactive discussion about end-of-life care in PMBT, but prospective studies are needed. © The Author(s) 2015. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

publication date

  • January 2016

has subject area

  • Aged
  • Brain Neoplasms
  • Cohort Studies
  • Female
  • Home Care Services
  • Hospice Care
  • Humans
  • Male
  • Middle Aged
  • Referral and Consultation
  • Retrospective Studies
  • Risk Factors

Research

keywords

  • Journal Article

Identity

Language

  • eng

PubMed Central ID

  • PMC4677417

Digital Object Identifier (DOI)

  • 10.1093/neuonc/nov156

PubMed ID

  • 26261221

Additional Document Info

start page

  • 78

end page

  • 86

volume

  • 18

number

  • 1