Dependency on help to complete daily tasks a good predictor of need for hospice

Patients exhibiting at least one Activities of Daily Living dependency had a 40% relative increase in perceived need for hospice care, according to recently published data. This need for help with daily activities may be a more accurate predictor of patients in need of hospice than those required by Medicare policies.

The Medicare Hospice Benefit requires that patients acknowledge hospice care is palliative, not curative. This new research has found that the policy may not identify patients with the greatest perceived need for hospice services.

Researchers recruited 300 patients to test whether those willing to abandon curative treatment had a need for hospice care greater than patients who wanted to continue treatment. They found that 13% of patients would decline further treatment even with an almost 100% guarantee of six-month survival, but neither those patients nor their families demonstrated increased perceived need for hospice care.

The researchers found that black patients, those with at least four Activities of Daily Living dependencies, those with the worst tangible social support score and those with a maximum psychological symptom burden all had greater perceived need. They concluded that patients (n=40) with at least one ADL dependency had the greatest perceived need.

“In short, hospice appears to be an important Medicare benefit that is widely valued by patients and families,” the researchers wrote. “Therefore, it is essential that access to this benefit be guided by eligibility criteria that are fair and consistent.”

J Clin Oncol. 2008;doi10.1200/JCO.2008.17.8079.