Cancer complications topped reasons for GI tract surgery prior to hospice admission
Most gastrointestinal tract surgeries performed before hospice admission were for urgent or emergent complications of cancer and required patient hospitalization in the preceding 3 years, according to a California-based cohort study.
The researchers also found that those readmitted to the hospital after hospice enrollment tended to be from underserved groups.
“These findings suggest multiple opportunities for advance care planning, with a particular focus on emergent care as well as a need for tailored approaches for equitable end-of-life care,” Anya L. Greenberg, MBA, and colleagues from the department of surgery at the University of California, San Francisco, wrote in JAMA Network Open.
To characterize patients who transition to hospice after GI tract surgery and identify areas that warrant further intervention, Greenberg and colleagues used patient discharge data from the California Office of Statewide Health Planning and Development to identify 2,688 adults (mean age, 73.2 years; 54.3% women; 62.3% white) who were discharged to hospice after surgical hospitalization for a digestive disorder between 2015 and 2019. Researchers used the Distressed Community Index (DCI) as a marker for patients’ socioeconomic status.
Among these patients, 88.9% had urgent or emergent discharges, with cancer (57.3%) and bowel obstruction (20.9%) accounting for the most common diagnoses. Researchers further reported a “considerable inpatient burden” among the cohort during the 3 years prior to hospice enrollment, with a mean 2.21 hospitalizations per patient, 25.8% of which were surgical.
“Our findings demonstrate the considerable burden of end-of-life care in this surgical cohort, including an escalating number of hospitalizations during the 3 years before hospice enrollment,” the researchers wrote. “This finding is striking given the well-established association between aggressive care and worse patient quality of life at the end of life, as well as patient preferences to avoid hospitalizations as they approach the end of life.”
Additionally, of 368 patients who were readmitted to the hospital after hospice enrollment, most were readmitted for infection and patients were more likely to be younger, have Medicaid, primarily speak a language other than English, come from a community with a higher DCI and were less likely to be white.
“These disparities are likely multifactorial, arising from demographic biases, clinician biases, language barriers and cultural considerations,” Greenberg and colleagues wrote. “In fact, clinicians have been shown to avoid advance care planning with patients of certain racial and ethnic groups and those who have limited English proficiency. Longitudinal
and tailored approaches to advance care planning in vulnerable surgical populations are needed to provide equitable, goal-concordant end-of-life care. Effective approaches will likely require multiple levels of intervention.”
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