Short Hospice Length of Service in a Comprehensive Cancer Center

Ramy Sedhom, Arjun Gupta, Thomas J. Smith

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The benefits of hospice for patients with advanced cancer are well established. Short hospice length of service (LOS) is a marker of poor quality care and patient and family dissatisfaction. Interventions based on behavioral science might reduce suboptimal hospice use. Objective: To assess effects of peer comparisons on rates of short hospice LOS for cancer patients at a tertiary comprehensive cancer center. Design: Pre-post design utilizing a peer-comparison feedback intervention comparing individual oncologist hospice data. Setting: Urban, academic, comprehensive cancer center in Maryland. Measurements: Hospice enrollment rate. Median hospice LOS and percentage short hospice LOS (defined as ≤7 days). Results: Sixty oncologists received the intervention. Before the intervention, 394 patients enrolled in hospice for a period of 21 months (18.76 enrollments per month). Median hospice LOS was 14.5 days. After the intervention, 418 patients enrolled in hospice for 14 months (29.85 enrollments per month). Median hospice LOS was nine days. The percentage of patients experiencing a short hospice LOS increased from 33.3% to 43.5%. Conclusions: The methods are not sufficient to conclude that the intervention does not improve hospice use. A substantial number of patients with cancer who used hospice had LOS ≤7 days, a marker of poor quality. Using peer comparison in combination with additional behavioral interventions should be considered to improve end-of-life care.

Original languageEnglish (US)
Pages (from-to)257-260
Number of pages4
JournalJournal of palliative medicine
Volume24
Issue number2
DOIs
StatePublished - Feb 2021
Externally publishedYes

Bibliographical note

Funding Information:
R.S. is supported by a National Institute of Aging Training Grant, T32AG000247.

Publisher Copyright:
© Copyright 2021, Mary Ann Liebert, Inc.

Keywords

  • audit-and-feedback
  • behavioral economics
  • end-of-life cancer care
  • hospice
  • nudge

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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