title: How should we design supportive cancer care? The patient's perspective.
abstract: OBJECTIVE
  Hospice services are designed to meet the needs of patients near the end of life. Although so-called open-access hospice programs and bridge programs are beginning to offer these services to patients who are still receiving treatment, it is not known whether they best meet patients' needs.
  
  
  METHODS
  Three hundred adult patients receiving treatment for cancer completed interviews in which each patient's value or ability for supportive care services were calculated from the choices that they made among combinations of those services. Preferences for five traditional hospice services and six alternative supportive care services were measured, and patients were followed up for 6 months or until death.
  
  
  RESULTS
  Patients' utilities for alternative services were higher than those for traditional hospice services (0.53 v 0.39; sign-rank test P < .001). Alternative services were also preferred among patients with poor functional status (Eastern Cooperative Oncology Group performance score > 2; n = 54; 0.65 v 0.48; P < .001) and among those who were in the last 6 months of life (0.68 v 0.56; sign-rank test P = .003). Even patients who were willing to forgo cancer treatment (n = 38; 13%) preferred alternative services (3.1 v 1.8; P < .001).
  
  
  CONCLUSIONS
  Patients who are receiving active treatment for cancer, and even those who are willing to stop treatment, express a clear preference for alternative supportive care services over traditional hospice services. Supportive care programs for patients with advanced cancer should reconsider the services that they offer and might seek to include novel services in addition to, or perhaps instead of, traditional hospice services.
authors.affiliation: University of Pennsylvania, 3615 Chestnut St, Philadelphia, PA 19104, USA. casarett@mail.med.upenn.edu
authors.forename: David
authors.initials: D
authors.lastname: Casarett
authors.forename: Jessica
authors.initials: J
authors.lastname: Fishman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: O'Dwyer
authors.forename: Frances K
authors.initials: FK
authors.lastname: Barg
authors.forename: Mary
authors.initials: M
authors.lastname: Naylor
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010358:Patient Participation; D011788:Quality of Life