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Understanding the Utility of Less Than Six-Month Prognosis Using Administrative Data Among U.S. Nursing Home
Long Vu1, Siran M Koroukian1,2,3, Sara L Douglas2,4
1Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Palliative Medicine Reports
|April 1, 2024
Summary
Documenting a prognosis of less than six months for cancer patients in nursing homes is linked to better end-of-life care. However, its low sensitivity limits its use for broader patient populations.
Area of Science:
- Oncology
- Geriatrics
- Palliative Care
- Health Services Research
Background:
- Limited research exists on the utility of prognostication for cancer patients in nursing homes.
- Accurate prognosis is crucial for tailoring end-of-life (EOL) care.
Purpose of the Study:
- To investigate factors associated with a documented prognosis of less than six months.
- To examine the relationship between this prognosis and EOL care quality in cancer patients residing in nursing homes.
Main Methods:
- Utilized linked Surveillance, Epidemiology, and End Results (SEER) and Medicare data for 20,397 US nursing home residents with cancer who died between July 2016 and December 2018.
- Identified 10.8% of residents with a documented less than six-month prognosis upon admission.
- Assessed aggressive EOL care markers (hospitalization, ED visits, ICU admission) and hospice/palliative care receipt; analyzed prognosis accuracy using six-month mortality.
Main Results:
- The documented less than six-month prognosis had high specificity (94.2%) but low sensitivity (13.7%) for predicting mortality.
- Residents with this prognosis had significantly higher odds of hospice admission (aOR: 3.27) and lower odds of receiving aggressive EOL care.
Conclusions:
- Documented less than six-month prognosis in nursing home cancer patients is associated with less aggressive EOL care.
- While specific, the low sensitivity of this prognostication limits its broad application for operationalizing care in terminal illness.
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