Quality of end-of-life care for cancer patients: Does home hospice care matter?

Objectives: Since metastasized cancer patients receive many treatments and services, it is important to ascertain whether home hospice (HH) care makes a meaningful contribution to end-of-life quality for terminal patients. This study examines whether people who had died from metastasized cancer - both recipients of HH care and nonrecipients - were cared for according to palliative indicators and whether HH care made a difference. Study Design: Three to 6 months after the deaths of 193 metastatic cancer patients, members of their families were interviewed face-to-face. Information on their loved ones' utilization of healthcare services in the last 2 months of life was retrieved from computerized administrative files. Results: The patients' average age was 69.5 years (SD = 13.9), 56% were men, and 21% received HH care. More patients with HH care than without received opiate medication (92% vs 68%, respectively; P <.01), appropriate treatment for anxiety (57% vs 30%, respectively; P <.01), had advance directives, and received explanations about their rights. Only 5% of HH patients were treated with curative care in the last 2 month of life, compared with 40% of those without HH ( P <.01). Of those who received curative care, more of them died at home (56% vs 26%, respectively; P <.01), and more died at the place of their choice (60% vs 30%, respectively; P <.01). No differences were found regarding healthcare service utilization. Conclusions: The findings demonstrate the valuable contributions of HH and palliative care. Clinicians should consider referring cancer patients to palliative care services and establishing working relationships with HH and palliative care providers.