Location of death and hospice use in children with cancer varies by type of health insurance

2021 ◽  
Author(s):  
Emily E. Johnston ◽  
Elizabeth S. Davis ◽  
Smita Bhatia ◽  
Kelly Kenzik
Keyword(s):  
Health Insurance ◽  
Children With Cancer ◽  
Location Of Death ◽  
Hospice Use

scholarly journals Descriptive Epidemiology in Mexican children with cancer under an open national public health insurance program

BMC Cancer ◽  
2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Roberto Rivera-Luna ◽  
Jaime Shalkow-Klincovstein ◽  
Liliana Velasco-Hidalgo ◽  
Rocio Cárdenas-Cardós ◽  
Marta Zapata-Tarrés ◽  
...  
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Public Health Insurance ◽  
Descriptive Epidemiology ◽  
Children With Cancer ◽  
Mexican Children ◽  
Insurance Program ◽  
Health Insurance Program ◽  
National Public Health

scholarly journals Impact of Timing and Location of Goals of Care Discussions for Patients with Blood Cancers

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 973-973 ◽  
Author(s):  
Oreofe O. Odejide ◽  
Angel M. Cronin ◽  
Anays Murillo ◽  
James A. Tulsky ◽  
Gregory A. Abel
Keyword(s):  
Medical Care ◽  
Outpatient Setting ◽  
Hospital Death ◽  
Goals Of Care ◽  
Icu Admission ◽  
Location Of Death ◽  
Lower Likelihood ◽  
Multivariable Models ◽  
Hospice Use ◽  
Eol Care

Abstract INTRODUCTION: Timely goals of care (GOC) discussions improve end-of-life (EOL) care for patients with solid malignancies. Although timely GOC discussions might also improve EOL care for patients with blood cancers, data are sparse regarding such discussions for this population. We studied the impact of timing and location of GOC discussions on quality of EOL care for a cohort of patients who died of blood cancers. METHODS: We assembled a retrospective cohort of blood cancer decedents from Dana-Farber Cancer Institute, Boston, MA. We included patients diagnosed with a blood cancer, who had ≥ 2 outpatient visits at the study institution, and who died between January 1 and December 31, 2014. Using the established definition from Mack et al, JCO 2012, we classified patients as having had a GOC discussion if there was any documentation in the medical record of a discussion involving resuscitation status, hospice, or preferred location of death. We abstracted content and location of the first documented GOC discussion. Next, we ascertained intensity of care near the EOL (i.e. chemotherapy ≤ 14 days before death, intensive care unit [ICU] admission ≤ 30 days before death, and hospital death) and hospice enrollment. Of note, decreased intensity of medical care and high rates of hospice enrollment are accepted indicators of quality EOL care. In univariable and multivariable models, we assessed the potential relationship between timing (> or ≤ 30 days before death) and location (outpatient or inpatient) of GOC discussions with intensity of medical care and hospice use near the EOL. RESULTS: Of the 384 eligible deceased patients, 39.1% had leukemia/myelodysplastic syndromes, 37.2% had lymphoma, and 23.7% had myeloma. 40.6% had undergone a hematopoietic stem cell transplant (HCT). Overall, 235 (61.2%) had a documented GOC discussion. The median time between first documented discussion and death was 15 days, with 33.2% of first discussions occurring > 30 days before death, and the minority (36.2%) occurring in the outpatient setting. The most commonly discussed topic was resuscitation preferences (82.6%), followed by hospice (30.6%); preferred location of death was rarely discussed (3.4%). Of the entire cohort, 16.9% received chemotherapy ≤ 14 days before death, 21.6% had at least one ICU admission ≤ 30 days before death, and 38.0% died in the hospital. 49.5% of the study population experienced at least one indicator of high-intensity medical care near the EOL. The rate of hospice use was 24.2%. In univariable analyses among those who had EOL discussions (n=235), having the first GOC discussion > 30 days before death was significantly associated with a lower likelihood of ICU admission ≤ 30 days before death (14.1% vs. 40.8%, p<0.001) and a lower likelihood of hospital death (37.2% vs. 63.1%, p=0.0002; Figure). Significant differences persisted in multivariable models controlling for sex, age, diagnosis, and HCT status. There were no significant differences in chemotherapy receipt close to death or hospice use by timing of GOC discussions in univariable or multivariable models. Having the first GOC discussion in an outpatient setting was significantly associated with a lower likelihood of ICU admission ≤ 30 days before death (9.4% vs. 44.7%, p<0.001), lower likelihood of hospital death (25.9% vs. 70.7%, p<0.001) but no significant difference in chemotherapy use near death (Figure). Outpatient location of first GOC discussion was also significantly associated with higher rates of hospice use (41.2% vs. 24.0%, p=0.006). Significant associations persisted in multivariable analyses. CONCLUSIONS: In this large cohort of patients who died of blood cancers, nearly 40% did not have a documented GOC discussion. For those who did, most GOC discussions occurred close to death and in the inpatient setting. Moreover, when patients had GOC discussions greater than a month before death and in the outpatient setting, they were more likely to experience high-quality EOL care. Figure Figure. Disclosures No relevant conflicts of interest to declare.

Impact of planning the location of death in children with cancer

2005 ◽  
Vol 23 (16_suppl) ◽  
pp. 8063-8063 ◽  
Author(s):  
V. Dussel ◽  
J. M. Hilden ◽  
J. Watterson ◽  
C. Moore ◽  
J. C. Weeks ◽  
...  
Keyword(s):  
Children With Cancer ◽  
Location Of Death

scholarly journals Predictors of Location of Death for Children with Cancer Enrolled on a Palliative Care Service

2018 ◽  
Vol 23 (12) ◽  
pp. 1525-1532 ◽  
Author(s):  
Erica C. Kaye ◽  
Samantha DeMarsh ◽  
Courtney A. Gushue ◽  
Jonathan Jerkins ◽  
April Sykes ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Children With Cancer ◽  
Location Of Death

Persistent racial and ethnic differences in location of death for children with cancer

2015 ◽  
Vol 62 (8) ◽  
pp. 1403-1408 ◽  
Author(s):  
Philip B. Cawkwell ◽  
Sharon L. Gardner ◽  
Michael Weitzman
Keyword(s):  
Ethnic Differences ◽  
Children With Cancer ◽  
Racial And Ethnic Differences ◽  
Location Of Death

scholarly journals Location of end-of-life care of children with cancer: a systematic review of parent experiences

2021 ◽  
Author(s):  
Michelle Noyes ◽  
Anthony Herbert ◽  
Susan Moloney ◽  
Helen Irving ◽  
Natalie Bradford
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospital Staff ◽  
Hospital Environment ◽  
Life Care ◽  
Children With Cancer ◽  
Parental Decision Making ◽  
Location Of Death

Objective: To synthesise existing qualitative research exploring the experiences of parents caring for children with cancer during the end-of-life phase, and the factors that influence parental decision making when choosing the location of end-of-life care and death for their child. Results: This review included 15 studies involving 460 parents of 333 children and adolescents who died from progressive cancer. Where reported, the majority (58%) of children died at home or in a hospital (39%), with only a small fraction dying in a hospice. Factors impacting decision-making for location of care included the quality of communication and the quality of care available. Themes related to choosing home for end-of-life care and death included: honouring the child’s wishes, familiarity of home, and parents’ desire to be their child’s primary carer. Preference for location of death in hospital included trust in hospital staff, practical logistics and the safety of the hospital environment.

Hospice use at end of life in children with cancer: The effect of insurance.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10558-10558
Author(s):  
Emily E. Johnston ◽  
Elizabeth Davis ◽  
Smita Bhatia ◽  
Kelly Kenzik
Keyword(s):  
End Of Life ◽  
Hospice Care ◽  
Private Insurance ◽  
Hematologic Malignancies ◽  
Insurance Status ◽  
Children With Cancer ◽  
Location Of Death ◽  
National Quality ◽  
Eol Care ◽  
Privately Insured

10558 Background: The National Quality Forum has endorsed hospice care as a metric of high quality end-of-life (EOL) care for adults with cancer. Specific hospice-related quality metrics include hospice enrollment, hospice enrollment for ≥3d, and death outside of the acute care setting. These metrics have been examined extensively in adults and disparities related to a number of clinical and sociodemographic factors, including insurance, have been identified. However, for children with cancer, hospice utilization data is lacking. We addressed this gap by examining location of death and hospice utilization at EOL for children with cancer and determining whether these metrics varied with insurance status. Methods: We used national insurance claims data (Truven) to conduct a population-based analysis of patients with cancer who died between 2011 and 2017 at age 0-21y. The dataset was queried for hospice claims, inpatient claims, and location of death. The association between insurance (private vs. Medicaid) and 1) location of death, 2) hospice enrollment, and 3) days between first hospice claim and death was examined using multivariable regression analysis, adjusting for age at death, gender, and cancer diagnosis (hematologic malignancies vs. solid tumor). Results: A total of 1,492 children died at a mean age of 11y (SD: 6y); 56% were privately-insured, 56% were male, and 30% had hematologic malignancies. Overall, 58% died in the hospital (privately-insured: 54% vs. Medicaid: 63%). Forty-five percent enrolled in hospice (privately-insured: 46% vs. Medicaid: 43%) with 2% returning to the hospital to die after enrolling in hospice. The average time between first hospice claim and death was 3d (privately-insured: 10d vs. Medicaid: 2d, p = < 0.001). When compared to privately-insured children, children on Medicaid had similar likelihood of hospice enrollment (RR = 1.0, 95%Cl = 0.6-1.8). However, children on Medicaid were more likely to die in the hospital (RR = 1.3, 95%CI = 1.1-1.4) and have fewer days between hospice enrollment and death if enrolled in hospice (IRR: 0.5, 95%CI = 0.3-0.8). Conclusions: In this first study to examine national hospice utilization in children with cancer, care varies significantly with insurance status. Children on Medicaid are more likely to die in the hospital and have shorter hospice enrollment duration than children with private insurance. Whether this variation represents EOL care preferences, provider biases, differences in quality and availability of hospice or home care to different insurers, or other barriers needs to be examined.

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