Oncologist Peer Comparisons as a Behavioral Science Strategy to Improve Hospice Utilization

Area of Science:

• Oncology
• Health Services Research
• Behavioral Science

Background:

• Hospice utilization metrics are crucial for improving end-of-life care in oncology.
• Oncologists often lack personalized reports on their hospice utilization rates.
• Behavioral science interventions, like peer comparisons, can address suboptimal decision-making.

Purpose of the Study:

• To evaluate if a behavioral science intervention using peer comparisons and social norms improves hospice utilization among oncologists.
• To assess the impact of personalized reports on hospice use metrics in cancer care.

Main Methods:

• A randomized controlled trial involving 47 oncologists at Johns Hopkins Medicine.
• Intervention group received email reports comparing their hospice utilization to top-performing peers.
• Control group received no reports; primary outcome was short hospice length of stay (LOS ≤ 7 days).

Main Results:

• The intervention group had a significantly lower proportion of patients with short hospice stays (17.4% vs. 46.3%).
• Peer comparisons were associated with increased hospice enrollment rates (73.7% vs. 42.8%).
• The median hospice length of stay was longer in the intervention group (37.2 days vs. 18.3 days).

Conclusions:

• Peer comparison reports effectively improved hospice utilization metrics among academic oncologists.
• Behavioral science provides a pragmatic strategy to mitigate oncologist decision-making biases regarding hospice care.
• This intervention demonstrates a potential pathway to enhance end-of-life care quality in oncology.