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Open Access Unplanned hospitalizations for metastatic cancers: The changing patterns of inpatient palliative care, discharge to hospice care, and in-hospital mortality in the United States

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Objective: To describe the rates and temporal trends of inpatient end-of-life care among patients hospitalized with metastatic cancer in the United States.

Methods: We used data from the Nationwide Inpatient Sample to conduct a cross-sectional analysis of unplanned inpatient hospitalizations of patients aged 18 years or older with metastatic cancer from 2002 to 2011. Multivariable logistic regression was used to assess patient-and hospital-level predictors of discharge to hospice care, palliative care, and in-hospital mortality. Temporal trends in outcomes were characterized with use of joinpoint regression.

Results: There were an estimated 350,241 unplanned hospitalizations per year of patients with a diagnosis of metastatic cancer. During their inpatient stay, 5.8% of patients received palliative care, and among those discharged alive, 12.2% were referred to hospice care. The rate of inpatient palliative care increased from 2.3% to 13.6%, the rate of discharge to hospice care increased from 4.1% to 15.6%, and the in-hospital mortality rate decreased from more than 14.0% to 9.8%. These patterns were consistent across cancer subtypes, and were most pronounced among patients with extreme risk of mortality.

Conclusion: Despite increases in the provision of comfort-oriented care to patients with metastatic cancer, few receive such services. We recommend screening protocols in hospitals to identify patients who are good candidates for palliative care consultation and hospice referral.
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Keywords: End-of-life; hospice care; inpatient mortality; metastatic cancer; palliative care; unplanned hospitalization

Document Type: Research Article

Publication date: May 1, 2017

This article was made available online on April 26, 2017 as a Fast Track article with title: "Unplanned hospitalizations for metastatic cancers: The changing patterns of inpatient palliative care, discharge to hospice care, and in-hospital mortality in the United States".

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  • Family Medicine and Community Health (FMCH) is an open-access journal focusing on subjects that are common and relevant to family medicine/general practice and community health. The journal publishes relevant content across disciplines such as epidemiology, public health, social and preventive medicine, research and evidence based medicine, community health service, patient education and health promotion and health ethics. The journal has a specific focus on the management of chronic illness particularly diabetes, ischaemic heart disease, chronic heart failure, hypertension, bronchial asthma, chronic obstructive airways disease and common mental illness. FMCH is published by Compuscript on behalf of the Chinese General Practice Press

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