Patients with cancer referred to hospice versus a bridge program: patient characteristics, needs for care, and survival.
OBJECTIVE
The purpose of this study was to compare the characteristics and needs of patients with advanced cancer who were referred to hospice with those referred to a prehospice "bridge" program that is staffed by hospice nurses.


METHODS
Data were gathered through retrospective review of computerized clinical records using precoded data fields of 284 patients with cancer enrolled in a bridge program and 1,000 who enrolled in a hospice program. Patient characteristics, needs for supportive care at the time of enrollment, and survival were assessed.


RESULTS
Bridge patients were less likely to have Medicare or Medicaid (43% v 72%; odds ratio, 0.30; P <.001) and were younger (69 v 73 years, rank sum test; P <.001), more likely to be married (59% v 43%; odds ratio, 1.90; P <.001), and more likely to be in the highest income category (14% v 10%; odds ratio, 1.77; P =.009). Bridge patients had at least as many needs for care as did patients in hospice. Bridge patients lived significantly longer (median, 46 v 19 days; log-rank test of survivor functions, P <.001).


CONCLUSIONS
Patients referred to this bridge program had prognoses that are significantly better than those of patients who enter hospice, but they have needs for supportive care that are at least as great. These findings underscore the importance of initiatives to extend some of the benefits of hospice care to a wider population of patients and should encourage the analysis of similar programs' ability to meet these needs.
Philadelphia Veterans Affairs Medical Center, PA, USA. casarett@mail.med.upenn.edu
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Casarett
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Abrahm
D000368:Aged; D005260:Female; D006301:Health Services Needs and Demand; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000458:organization & administration*; D006738:Hospices / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D008389:Marketing of Health Services; D008484:Medicaid; D006278:Medicare; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D010414:Pennsylvania / Q000453:epidemiology; D012017:Referral and Consultation; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States