|
 Medicare, the U.S. health insurance program for the elderly that
also covers Americans with kidney failure, will not pay for dialysis
and hospice at the same time. This forces terminally ill patients to
choose between continuing on dialysis or accessing hospice care,
which may provide more comfort and support at the end of life,
researchers note in JAMA Internal Medicine.
For the current study, researchers examined data on more than
770,000 dialysis patients covered by Medicare who died between 2000
and 2014. Overall, just one in five were receiving hospice services
when they died.
Among patients who did receive hospice care, 42 percent were
enrolled for three or fewer days. Compared with dialysis patients
who didn't receive hospice care, those enrolled in hospice for three
or fewer days were more likely to have been hospitalized or admitted
to intensive care units (ICU) in the last month of life. But they
were less likely to die in the hospital or undergo invasive
procedures.
"We found that people on dialysis who did enroll in hospice spent
much less time in hospice than patients with other serious illnesses
like cancer and heart disease, and those who did spend more time on
hospice had lower healthcare costs," said lead study author Dr.
Melissa Wachterman, a researcher at Harvard Medical School and
Brigham and Women's Hospital in Boston.
Hospice is a benefit typically available to people with a life
expectancy of six months or less. People in hospice generally stop
active treatment and instead receive care focused on comfort as well
as emotional support for patients and their loved ones.
Terminal kidney failure patients can have intense pain and worse
quality of life than people with cancer or dementia at the end of
life, Wachterman said by email.
"Patients with kidney failure stand to benefit greatly from the care
hospice has to offer and yet they are about half as likely to
receive hospice as those with other serious illnesses like cancer
and heart disease," Wachterman said.
One goal of hospice is also to avoid costly and often unnecessary
interventions that don't improve quality of life or extend longevity
for people with terminal illnesses.
[to top of second column] |
In the current study, average Medicare costs over the last week of
life were similar for dialysis patients who didn't go to hospice and
those who enrolled only for three or fewer days before they died.
Without hospice, the tab came to $10,871 compared with $10,756 with
a brief hospice stay.
But when patients spent more than 15 days in hospice before they
died, average Medicare costs over the final week of life were
$3,221.
Just 35 percent of these patients who had longer hospice stays were
admitted to the hospital in the last month of life, compared with 84
percent of people with three or fewer days in hospice.
"Any use of hospice greatly improves the opportunity to avoid dying
in a hospital," said Dr. Laura Hanson of the palliative care program
at the University of North Carolina Chapel Hill.
"However, patients who enroll in hospice earlier are also avoiding
intensive care and hospital stays in the month prior to death,"
Hanson, who wasn't involved in the study, said by email. "Accepting
hospice earlier allows patients to make additional choices about
their care."
Still, transitioning from dialysis to hospice is a wrenching
decision for patients and families, Hanson said.
"It takes courage," said Dr. S. Vanita Jassal, director of geriatric
and palliative renal care at the University Health Network in
Toronto.
"Patients have often been coached not to miss a session or they
could die," Jassal, who wasn't involved in the study, said by email.
"We also don't talk about death and how it is inevitable; we often
don't empower our patients to tell us when enough is enough."
SOURCE: https://bit.ly/2s3lxN5 and https://bit.ly/2J3CosO JAMA
Internal Medicine, online April 30, 2018.
[© 2018 Thomson Reuters. All rights
reserved.] Copyright 2018 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content. |
