Hospice and Emergency Room Use by Disadvantaged Men Dying of Prostate Cancer

Published In: The Journal of Urology, v. 181, no. 5, May 2009, p. 2084-2089

Posted on RAND.org on January 01, 2009

by Jonathan Bergman, Lorna Kwan, Arlene Fink, Sarah Connor, Mark Litwin

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PURPOSE: Hospice care has been found to improve symptom management, quality of death and quality of life at the end of life. The authors describe hospice use by a cohort of low income, uninsured men with prostate cancer enrolled in a public assistance program. They ascertained whether hospice enrollment was associated with a decrease in the number of prostate cancer related emergency room visits made before death. MATERIALS AND METHODS: The authors studied all 57 low income, uninsured men in a public assistance program who had died since its inception in 2001. The association between sociodemographic and clinical data, and hospice enrollment data were evaluated. RESULTS: The overall rate of hospice use was 28% (16 of 57 patients). The mean plus or minus SD duration of hospice enrollment before death was 44 plus or minus 43 days (median 34, range 2 to 143). Two patients (12%) were enrolled fewer than 7 days and none were enrolled more than 180 days. Prostate cancer related emergency room visits, adjuvant chemotherapy treatment, evidence of metastasis at initial presentation and death from prostate cancer were significantly associated with hospice use (p <0.05). We noted a trend toward fewer mean emergency room visits made by men enrolled in hospice care than by those not enrolled (0.7 plus or minus 1.3 vs 1.1 plus or minus 0.9, p = 0.15). CONCLUSIONS: Hospice use and the duration of enrollment by low income, uninsured men dying of prostate cancer was comparable to previously reported hospice use by insured individuals. Hospice enrollment was associated with fewer prostate cancer related emergency room visits.

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