Patients who die from cancer in states with palliative care laws are 12% to 18% more likely to die at home or in hospice, according to a new study.
About 85% of patients in the United States prefer to die at home, but only 40% do so at home or in hospice, the investigators reported. Those who die in healthcare settings often receive aggressive end-of-life care, which often does not improve the chances of survival and is linked to a decrease in quality of life for the patient and worse bereavement adjustment for family members, they added.
Palliative care, which seeks to mitigate serious health-related suffering due to severe illness, especially near the end of life, may help to keep patients in their chosen setting with more appropriate care, the investigators noted. In the current study, they sought to determine whether states’ laws that support palliative care communications between doctor and patient make a difference in place of death for these patients.
The analysis included state legislation information combined with death certificate data for the 50 U.S. states from 2005 through 2017. Data came from records for all deceased patients with any type of cancer listed as the underlying cause of death (more than 7.5 million). They also looked at the presence of laws related to palliative and end-of-life care in the state where death occurred.
More than half (50.1%) of the patients died at home or in hospice. Most (71%) died in states without a palliative care law. But 16% died in states with a non-prescriptive palliative care law which did not prescribe clinical action, and 13% died in states with a prescriptive law that required clinicians to offer patients information about their care options.
There was a 12% higher likelihood of dying at home or in hospice for decedents in states with a non-prescriptive palliative care law, and an 18% higher likelihood of these outcomes for decedents in states with a prescriptive palliative care law.
The finding that states’ palliative care laws have an effect on place of death is noteworthy “given the difficulty with improving palliative and end-of-life care delivery in the U.S.,” the authors wrote. State-level interventions may have a broader reach than a patient-level intervention and may require fewer additional resources, they noted.
These laws could help prompt “high-quality communication among clinicians, patients and their healthcare proxies to ensure that patients’ goals of care are honored at the end of life,” while complementing established interventions such as the Physicians Orders for Life-Sustaining Treatment (POLST) or advance care planning, they concluded.
The study was published in JAMA Network Open.
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