Table 2.
Quality of Care and Quality of Dying in Decedents with and without Hospice
| Outcome | Non-Hospice (n = 278) |
Hospice (n = 208) |
Hospice, Too Late (n = 33) |
Adjusted Odds Ratio (95% Confidence Interval)* |
|---|---|---|---|---|
| Overall problem score, mean (range 0–8)† | 1.2 | 0.74 | 2.7 | 0.49 (0.33–0.74) |
| Components of the problem score, % with component | ||||
| Unmet need for management of pain | 11.7 | 7.0 | 28.6 | 0.51 (0.18–1.45) |
| Unmet need for management of dyspnea | 19.1 | 6.1 | 31.3 | 0.22 (0.10–0.54) |
| Patient was always treated with respect | 81.6 | 79.9 | 57.6 | 1.00 (0.62–1.57) |
| Family wanted more information on what to expect while patient was dying | 22.5 | 11.1 | 48.5 | 0.41 (0.23–0.70) |
| Family wanted more information regarding how pain was managed | 16.9 | 8.1 | 31.8 | 0.54 (0.29–1.00) |
| Family wanted more information on what to do at time of death | 25.1 | 11.8 | 51.5 | 0.34 (0.23–0.53) |
| Family wanted more help regarding spiritual and religious concerns | 10.6 | 7.3 | 21.2 | 0.64 (0.37–1.10) |
| Family wanted more emotional support regarding their grief before patient’s death | 22.7 | 14.0 | 43.8 | 0.50 (0.36–0.70) |
| Rating of quality of care, mean‡ | 31.6 | 34.3 | 25.4 | 2.30 (1.69–3.13) |
| Provided medical care that respected medical wishes, % | 8.2 | 8.8 | 7.2 | 1.94 (1.48–2.57) |
| Symptoms were controlled to desired level, % | 8.2 | 8.7 | 6.6 | 1.54 (1.10–2.15) |
| Emotional support provided to patient and family, % | 7.4 | 8.1 | 5.5 | 2.00 (1.36–2.83) |
| Communicate with family about medical condition, % | 7.7 | 8.5 | 5.8 | 2.30 (1.59–3.34) |
| Peacefulness of dying (1 = very much at peace, 10 = very much not at peace) | 1.8 | 1.1 | 2.4 | 0.51 (0.35–0.74) |
| Quality of dying (1 = a very poor death, 10 = a very good death) | 8.4 | 8.9 | 7.5 | 1.68 (1.11–2.56) |
*
Results compare persons receiving hospice at the right time with those who did not receive hospice after adjusting for state, age, sex, race, respondent relationship, and years of education.
†
Overall problem score is based on 8 items that measure whether the family member had a concern with the quality of care or an unmet need.
‡
Based on four items that ask the respondent to rate care between 0 (the worst care) and 10 (the best care). The four items are added to create a score between 0 and 40.