PA Medical News about Hospice; Older Persons; Advanced Illness

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Understanding their Options: Determinants of Hospice Discussion for Older Persons with Advanced Illness
Journal of General Internal Medicine, 06/11/09

Thomas JM et al. - Clinicians reported discussing hospice with 46% of patients with cancer, compared to 10% with COPD and 7% with HF. Apart from diagnosis of cancer, the factors most strongly associated with hospice discussion were clinicians’ estimate of and certainty about patient life expectancy. However, clinicians were unable to anticipate the deaths of a considerable portion of patients (40%). Although patient unwillingness to undergo minor medical interventions was associated with hospice discussion, a sizeable portion of clinicians (40%) whose patients reported this characteristic did not have the discussion. Clinicians’ discussion of hospice independently increased the likelihood of hospice use. Clinicians’ discussion of hospice for patients with advanced illness, and, ultimately, patients’ use of hospice, relies largely on clinician estimates of patient life expectancy and the predictability of disease course. Many clinicians whose patients might benefit from learning about hospice are not having these discussions.

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