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Hospice Patients Are Now Living Longer

By Debra Wood, RN, contributor

Despite a common misperception that palliative symptom relief may hasten death, a new study found that hospice care may prolong the lives of some terminally ill patients.

“Because of the incredible management from a medical point of view that goes on with hospice, people stabilize,” said Carol Spence, RN, MS, director of research for the National Hospice and Palliative Care Organization (NHPCO), the study's sponsor. “This confirms what those of us in the field have seen with their patients and caseloads.”

Michael E. Schmidt, RN, general manager of VITAS Innovative Hospice Care in Walnut Creek, California, was not surprised by the findings, saying that while prolonging life is not the goal, the additional care hospice brings to a patient and family may result in additional time.

Spence said people often assume hospice services result in an abandonment of medical standards of care, but that’s not the case.

“Hospice is not less care; it’s a different kind of care,” Spence said. “And it’s possible to do better on hospice because of the coordination and all of the other services.”

Using data from the Centers for Medicare and Medicaid Services, researchers analyzed the difference in survival periods for 4,493 terminally ill patients. The study, reported in the Journal of Pain and Symptom Management, found that hospice patients' mean survival was 29 days longer than similarly ill patients not receiving hospice services. Congestive heart failure patients experienced the greatest difference in survival, with those enrolled in hospice living 81 days longer than their peers.

Lead author Stephen Connor, PhD, NHPCO vice president, said heath care providers often fear that sedatives or opioids for symptom relief could hasten death, but that’s not the case.

“This study provides important information to suggest that hospice is related to the longer, not shorter length of survival–by days or months–in many patients,” said Connor, in a written statement. “This additional time may be valuable to patients and families to give more time for resolution and closure.”

The researchers felt several factors could have contributed to the survival difference. Weak patients avoid the risks of over-treatment. Hospice may provide closer monitoring. The interdisciplinary approach and support for family caregivers may increase patients’ desire to live and may make them feel less of a burden to their families.

Kathleen LaPorte, RN, a senior general manager of the Brevard County program for VITAS Innovative Hospice Care in Florida, recalled admitting patients in pain, who after receiving appropriate medications, were up and socializing with their families on subsequent visits.

“We want people to live as full as they can,” LaPorte said. “So many times, people have more time and a better quality time, because of the interventions we have done with them.”

Unfortunately, patients often are referred to hospice late in their course of illness. That leaves less time for working through psychosocial issues.

In another NHPCO study released this year, researchers found that families who felt their dying loved ones were referred too late reported more unmet needs and lower satisfaction with the quality of care.

“When you have a short time, you are in a crisis mode, trying to get the plan in place quickly,” LaPorte said. “When patients are on service longer, you have an opportunity to control symptoms and focus on issues like giving families an opportunity to get affairs in order, to say their good-bye and to prepare the family for the loss. It’s hard to prepare somebody for a loss in 24 to 48 hours.”

Schmidt said hospice care produces the best outcomes when the team has at least 60 days to work with the patient and family, yet at least 45 percent of the patients admitted to his program die within nine days.

“We have barely enough time to get to know our patients and families, and get our arms around the many challenges facing them,” Schmidt said. “It’s a tragedy on an individual level, a family level and on a social and community level.”

Schmidt attributes delayed referrals to patients’ biological need to survive and a society focused on youth and curative care. He said physicians and other health providers do not receive sufficient training in helping people transition from aggressive to palliative care.

“We know from experience, [hospice] can make a difference,” Schmidt said.