Hospice Referral in Advanced Cancer in New Jersey

Area of Science:

• Palliative Care
• Health Services Research
• Oncology

Background:

• The demand for hospice care is growing in the U.S., yet challenges like short lengths of stay and unequal access remain.
• Limited research exists on how symptoms influence hospice referrals, particularly for patients with advanced cancer.

Purpose of the Study:

• To investigate the association between hospice referral and demographic factors, as well as the presence of pain and depression.
• To identify disparities in hospice access among diverse patient populations with metastatic cancer.

Main Methods:

• Secondary analysis of the 2018 New Jersey State Inpatient Database.
• Inclusion of adult patients diagnosed with metastatic cancer.
• Generalized linear modeling to assess the impact of pain and depression on hospice referral rates.

Main Results:

• Absence of pain (adjusted odds ratio [AOR], 0.44) and depression (AOR, 0.85) were associated with lower odds of hospice referral.
• Black (AOR, 0.86) and Hispanic (AOR, 0.84) patients, and those with a non-English primary language (AOR, 0.85), had significantly lower odds of referral.
• Patients experiencing both pain and depression showed increased hospice referrals.

Conclusions:

• Pain and depression are linked to higher hospice referral rates.
• Significant disparities in hospice access persist for racial/ethnic minorities and non-English speakers.
• Addressing these disparities is crucial for equitable end-of-life care delivery.