Terminally ill patients have a variety of hospice care models available to them at the end of life (EOL). But determining which model of hospice care is most appropriate and best suited to their needs can be challenging.
A group of researchers investigated how to determine which is the most appropriate hospice delivery care model to recommend based on a patient’s specific physical, spiritual, and psychosocial needs. The results of the study were published in BMJ Supportive & Palliative Care.
For this large cohort study, the team evaluated data from 8874 hospice patients who had received 1 type of hospice care between 2006 and 2020 at a large medical center in Taiwan. Of those, 7076 (79.7%) received hospice share care, 918 (10.4%) received hospice inpatient care, and 880 (9.9%) received hospice home care.
The patients who received hospice home care services were less likely to experience dysphagia and dyspnea. Those who received hospice inpatient care were more likely to have higher symptom severity and greater psychosocial distress.
Among patients with lung cancer, those who received hospice home care services had better survival rates than those who received another type of hospice care.
The hospice share care model was appropriate for terminally ill patients who did not have cancer.
“Our data support the use of a comprehensive hospice care assessment to guide the selection of an appropriate hospice care model for terminally ill patients,” the researchers explained. Based on comprehensive hospice assessments and symptom characteristics, care was individualized to target improved EOL. In the future, a focus on the patients’ needs and characteristics could indicate a need to change hospice services.
Study limitations were that all the data came from a single institution, limiting its generalizability; and were from referred patients, with clinicians in Taiwan limiting their referrals to patients with poor performance status scores. Other factors also might influence overall survival.
The researchers suggest that further research could focus on developing standardized screening processes that could anticipate patients’ palliative care needs and predict the likely trajectory of their functional decline.
Disclosure: This research was supported by the Ministry of Science and Technology, Taiwan, and the Ministry of Health and Welfare.
Lai WS, Liu IT, Tsai JH, et al. Hospice delivery models and survival differences in the terminally ill: a large cohort study. BMJ Support Palliat Care. Published online December 16, 2021. doi:10.1136/bmjspcare-2021-003262