The Care Span
THE CARE SPANEnd-Of-Life Care For Medicare Beneficiaries With Cancer Is Highly Intensive Overall And Varies Widely
- Nancy E. Morden ( [email protected] ) is an assistant professor at the Dartmouth Medical School, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice, and an investigator in the Cancer Control Research Program at the Dartmouth-Hitchcock Norris Cotton Cancer Center, in Lebanon, New Hampshire.
- Chiang-Hua Chang is a research instructor at the Dartmouth Institute for Health Policy and Clinical Practice.
- Joseph O. Jacobson is the chief quality officer at the Dana Farber Cancer Institute, in Boston, Massachusetts, and an associate clinical professor at Harvard Medical School.
- Ethan M. Berke is an associate professor at Dartmouth Medical School, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice, and an investigator in the Cancer Control Research Program at the Dartmouth-Hitchcock Norris Cotton Cancer Center.
- Julie P.W. Bynum is an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice and associate director of the institute’s Center for Health Policy Research.
- Kimberly M. Murray is a research associate at the Maine Medical Center Research Institute’s Center for Outcomes Research and Evaluation, in Portland.
- David C. Goodman is a professor of pediatrics and of health policy at Dartmouth Medical School and director of the Center for Health Policy Research at the Dartmouth Institute.
Abstract
Studies have shown that cancer care near the end of life is more aggressive than many patients prefer. Using a cohort of deceased Medicare beneficiaries with poor-prognosis cancer, meaning that they were likely to die within a year, we examined the association between hospital characteristics and eleven end-of-life care measures, such as hospice use and hospitalization. Our study revealed a relatively high intensity of care in the last weeks of life. At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit status. We found that these hospital characteristics explained little of the observed variation in intensity of end-of-life cancer care and that none reliably predicted a specific pattern of care. These findings raise questions about what factors may be contributing to this variation. They also suggest that best practices in end-of-life cancer care can be found in many settings and that efforts to improve the quality of end-of-life care should include every hospital category.
