title: End-of-life care for Medicare beneficiaries with cancer is highly intensive overall and varies widely.
abstract: Studies have shown that cancer care near the end of life is more aggressive than many patients prefer. Using a cohort of deceased Medicare beneficiaries with poor-prognosis cancer, meaning that they were likely to die within a year, we examined the association between hospital characteristics and eleven end-of-life care measures, such as hospice use and hospitalization. Our study revealed a relatively high intensity of care in the last weeks of life. At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit status. We found that these hospital characteristics explained little of the observed variation in intensity of end-of-life cancer care and that none reliably predicted a specific pattern of care. These findings raise questions about what factors may be contributing to this variation. They also suggest that best practices in end-of-life cancer care can be found in many settings and that efforts to improve the quality of end-of-life care should include every hospital category.
authors.affiliation: Dartmouth Medical School, Lebanon, New Hampshire, USA. nancy.e.morden@dartmouth.edu
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Morden
authors.forename: Chiang-Hua
authors.initials: CH
authors.lastname: Chang
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Jacobson
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Berke
authors.forename: Julie P W
authors.initials: JP
authors.lastname: Bynum
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Murray
authors.forename: David C
authors.initials: DC
authors.lastname: Goodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D006278:Medicare; D009369:Neoplasms / Q000401:mortality; D010818:Practice Patterns, Physicians'; D013727:Terminal Care / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology