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Updated: May 8, 2025

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Hospice Use by Cause of Death: A Cohort Study Using Utah Population Database.

Rebecca L Utz1,2,3,4, Michael Hollingshaus5, Attrayee Bandyopadhyay1

  • 1Department of Sociology, College of Social & Behavioral Sciences, University of Utah, Salt Lake City, Utah, USA.

The American Journal of Hospice & Palliative Care
|April 29, 2025
PubMed
Summary

Hospice care patterns vary significantly by cause of death. Non-cancer patients, particularly stroke, dementia, and COPD, often experience suboptimal hospice use, highlighting a need for flexible end-of-life (EOL) care models.

Keywords:
United Statescancercause of deathdementia-ADRDhealth care accesshospicelive dischargemedicare hospice benefit

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Area of Science:

  • Gerontology
  • Palliative Care
  • Health Services Research

Background:

  • Hospice care, initially for cancer patients with <6 months prognosis, is now used across diverse life-limiting illnesses.
  • Illnesses like cancer have predictable decline, while Alzheimer's Disease and Related Dementias (ADRD) and Chronic Obstructive Pulmonary Disease (COPD) present protracted decline.
  • Current hospice eligibility and practices may not optimally serve all end-of-life (EOL) trajectories.

Purpose of the Study:

  • To determine if hospice utilization differs based on the underlying cause of death.
  • To evaluate whether existing hospice models provide optimal EOL care for all diagnoses.
  • To identify patterns of hospice use across various causes of death.

Main Methods:

  • Analysis of 17,321 hospice users from the Utah Population Database (UPDB) Caregiver Population Science (C-PopS) decedent cohort.
  • Multinomial regression analyses to model hospice length-of-stay by cause of death.
  • Kaplan-Meier Survival Curves used to visualize hospice use patterns.

Main Results:

  • Non-cancer decedents were more prone to suboptimal hospice use: 'minimal use' (<1 week) or 'extended use' (>6 months).
  • Stroke decedents showed the highest likelihood of 'minimal use' hospice patterns.
  • Dementia and COPD decedents were most likely to experience 'extended use' hospice patterns.

Conclusions:

  • Significant disparities exist in hospice care patterns based on the cause of death.
  • Current hospice frameworks may not adequately address the needs of patients with non-cancer diagnoses and prolonged EOL trajectories.
  • Development of flexible, hospice-like EOL care models is crucial to accommodate diverse patient needs and varying EOL trajectories.