ArticleJournal of oncology practice2017
Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer.
Article in Journal of oncology practice, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- A comparison of conceptual frameworks to examine health inequities in End-of-Life care.Journal of advanced nursing · 2023Pooled it
- Psychological Determinants of Physician Variation in End-of-Life Treatment Intensity: A Systematic Review and Meta-Synthesis.Journal of general internal medicine · 2023Pooled it
- Duration of palliative care before death in international routine practice: a systematic review and meta-analysis.BMC medicine · 2020Pooled it
- Days spent with healthcare contact by patients with metastatic castrate resistant prostate cancer in the last year of life.The oncologist · 2025Article
- Variation in Palliative Care Program Performance for Patients With Metastatic Cancer.Journal of pain and symptom management · 2025Article
- Social Determinants of Comfort: A New Way of Conceptualizing Pediatric End-of-Life Care.Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association · 2022Article
- Telemedicine Utilization in the Ambulatory Palliative Care Setting: Are There Disparities?Journal of pain and symptom management · 2022Article
- Cancer-related emergency and urgent care: expanding the research agenda.Emergency cancer care · 2022Review
- Access to Palliative Care Consultation for Hospitalized Adults with COVID-19 in an Urban Health System: Were There Disparities at the Peak of the Pandemic?Journal of palliative medicine · 2022Article
- Early-onset pancreatic cancer: an institutional series evaluating end-of-life care.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2021Article
- Increased in-hospital mortality and emergent cases in patients with stage IV cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2021Article
- Disparities in Hospice Utilization for Older Cancer Patients Living in the Deep South.Journal of pain and symptom management · 2019Article
- Association between physicianBMJ (Clinical research ed.) · 2018Observational
- Hospice utilization in patients with malignant gliomas.Neuro-oncology · 2018Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
purposeThe benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use.
methodsWe conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists.
resultsOf 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P < .01). In addition, there was dramatic variation in median LOS by individual physician (range, 4 to 88 days for physicians with five or more patients), indicating differences in hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population.
conclusionNearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.
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