The passage of state laws related to communication about palliative care options increases the likelihood that patients with cancer will spend their final days at home or in hospice care, rather than undergoing aggressive treatment interventions in hospitals or other healthcare settings.
Such laws were associated with a 12% to 18% greater likelihood that individuals with cancer would die at home or in hospice.
The finding comes from a cohort study that involved more than 7.5 million deceased patients whose underlying cause of death was cancer.
Half (50.1%) of these patients died at home or in hospice from January 1, 2005, to December 31, 2017.
"After we adjusted for possible confounders, dying in a state and during a year in which either a nonprescriptive or prescriptive palliative care law was in place was associated with a 12% or 18% increased likelihood of dying at home or in hospice [respectively]," Main Lin Quan Vega, MD, of Columbia University College of Physicians and Surgeons, New York, and colleagues report.
The findings were published online June 8 in JAMA Network Open.
"In the US, improving palliative and end-of-life care has become an important focus of public health," the authors write, noting that "25% of total Medicare expenditures are spent during the last year of life."
Although most seriously ill patients prefer less aggressive care at the end of life and want to avoid "being attached to machines and tubes," many patients die in healthcare settings and undergo "high-intensity care that may prioritize quantity over quality of life," the authors point out.
One solution is the provision of palliative care, they suggest.
"For the past 2 decades, there has been a steady increase in the establishment of palliative care in US hospitals," they comment. "In further efforts to improve end-of-life care, some states have enacted palliative care legislation aimed at facilitating access to information about available care options as patients approach the end of life, under the assumption that some of the discordant care provided may result from a lack of patient knowledge."
They set out in their study to see whether the passing of such laws has had a measurable impact on patient outcomes, and they found that, indeed, it has.
The team performed a difference-in-differences analysis using information about state legislation combined with death certificate data to assess the impact of such laws.
"In this study, we observed that a state-level intervention had a measurable association with place of death for individual decedents. This finding was noteworthy given the difficulty with improving palliative and end-of-life care delivery in the US," they said.
"An effective state-level intervention is appealing, as it necessarily has a broader reach than a patient-level intervention and may require fewer additional resources."
Indeed, state-level palliative care legislation could provide an effective intervention to increase the number of patients with serious illness who experience their death in preferred locations, they conclude.
However, the current findings and existing data also suggest that the extent to which palliative care laws may affect clinical care and outcomes "may be highly dependent on differences in implementation or environmental factors," they added.
Quan Vega has disclosed no relevant financial relationships.
JAMA Netw Open. Published online June 8, 2023. Full text
Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape, MDedge and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at email@example.com or on Twitter: @SW_MedReporter.
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