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Original Investigation
May 25, 2009

Discussions With Physicians About Hospice Among Patients With Metastatic Lung Cancer

Author Affiliations

Author Affiliations: Department of Health Care Policy, Harvard Medical School (Drs Huskamp, Keating, Zaslavsky, He, and Ayanian), Division of General Internal Medicine, Brigham and Women's Hospital (Drs Keating and Ayanian), and Division of Population Sciences, Dana-Farber Cancer Institute (Dr Weeks), Boston, Massachusetts; Department of Medicine (Dr Malin) and Division of General Internal Medicine (Dr Kahn), David Geffen School of Medicine, University of California, Los Angeles, and Veterans Affairs Health Care System, Greater Los Angeles (Dr Malin), Los Angeles; RAND Corporation, Santa Monica, California (Drs Malin and Kahn); Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (Dr Earle); Center for Gerontology and Health Care Research, Department of Community Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island (Dr Teno); and Department of Health Policy and Management, University of Minnesota, Minneapolis (Dr Virnig).

Arch Intern Med. 2009;169(10):954-962. doi:10.1001/archinternmed.2009.127

Background  Many terminally ill patients enroll in hospice only in the final days before death or not at all. Discussing hospice with a health care provider could increase awareness of hospice and possibly result in earlier use.

Methods  We used data on 1517 patients diagnosed as having stage IV lung cancer from a multiregional study. We estimated logistic regression models for the probability that a patient discussed hospice with a physician or other health care provider before an interview 4 to 7 months after diagnosis as reported by either the patient or surrogate or documented in the medical record.

Results  Half (53%) of the patients had discussed hospice with a provider. Patients who were black, Hispanic, non-English speaking, married or living with a partner, Medicaid beneficiaries, or had received chemotherapy were less likely to have discussed hospice. Only 53% of individuals who died within 2 months after the interview had discussed hospice, and rates were lower among those who lived longer. Patients who reported that they expected to live less than 2 years had much higher rates of discussion than those expecting to live longer. Patients reporting the most severe pain or dyspnea were no more likely to have discussed hospice than those reporting less severe or no symptoms. A third of patients who reported discussing do-not-resuscitate preferences with a physician had also discussed hospice.

Conclusions  Many patients diagnosed as having metastatic lung cancer had not discussed hospice with a provider within 4 to 7 months after diagnosis. Increased communication with physicians could address patients' lack of awareness about hospice and misunderstandings about prognosis.