Top

Published in:

01-04-2019 | Original Article

The experience of providing hospice care concurrent with cancer treatment in the VA

Authors: Leah M. Haverhals, Chelsea E. Manheim, Vincent Mor, Mary Ersek, Bruce Kinosian, Karl A. Lorenz, Katherine E. Faricy-Anderson, Risha A. Gidwani-Marszowski, Cari Levy

Published in: Supportive Care in Cancer | Issue 4/2019

Abstract

Purpose

Veterans with advanced cancer can receive hospice care concurrently with treatments such as radiation and chemotherapy. However, variations exist in concurrent care use across Veterans Affairs (VA) medical centers (VAMCs), and overall, concurrent care use is relatively rare. In this qualitative study, we aimed to identify, describe, and explain factors that influence the provision of concurrent cancer care (defined as chemotherapy or radiation treatments provided with hospice) for veterans with terminal cancer.

Methods

From August 2015 to April 2016, we conducted six site visits and interviewed 76 clinicians and staff at six VA sites and their contracted community hospices, including community hospices (n = 16); VA oncology (n = 25); VA palliative care (n = 17); and VA inpatient hospice and palliative care units (n = 18).

Results

Thematic qualitative content analysis found three themes that influenced the provision of concurrent care: (1) clinicians and staff at community hospices and at VAs viewed concurrent care as a viable care option, as it preserved hope and relationships while patient goals are clarified during transitions to hospice; and (2) the presence of dedicated liaisons facilitated care coordination and education about concurrent care; however, (3) clinicians and staff concerns about Medicare guideline compliance hindered use of concurrent care.

Conclusions

While concurrent care is used by a small number of veterans with advanced cancer, VA staff valued having the option available and as a bridge to hospice. Hospice staff felt concurrent care improved care coordination with VAMCs, but use may be tempered due to concerns related to Medicare compliance.

Available only for authorised users

This reflects the Hospice Election language: “The individual’s or representative’s (as applicable) acknowledgment that the individual has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment” [41].

Casarett D, Fishman J, Lu H, O’Dwyer P, Barg F, Naylor M et al (2009) The terrible choice: re-evaluating hospice eligibility criteria for cancer. J Clin Oncol 27:953–959. https://doi.org/10.1200/JCO.2008.17.8079 CrossRefPubMed

Casarett D (2011) Rethinking hospice eligibility criteria. JAMA 305:1031–1032. https://doi.org/10.1001/jama.2011.271 CrossRefPubMed

Lupu D, Ivanko B, Insana F, White P, Arnold R (2014) Hospice innovation impediments: can halfway efforts tame the terrible choice? J Palliat Med 17:1088–1090. https://doi.org/10.1089/jpm.2014.0268 CrossRefPubMed

Wright A, Katz I (2007) Letting go of the rope — aggressive treatment, hospice care, and open access. N Engl J Med 357:324–327. https://doi.org/10.1056/NEJMp078074 CrossRefPubMed

National Hospice and Palliative Care Organization (NHPCO) (2018) Facts and figures: hospice care in America. https://www.nhpco.org/sites/default/files/public/Statistics_Research/2017_Facts_Figures.pdf. Accessed 15 July 2018

Mor V, Teno J (2016) Regulating and paying for hospice and palliative care: reflections on the Medicare Hospice Benefit. J Health Polit Policy Law 41:697–716. https://doi.org/10.1215/03616878-3620893 CrossRefPubMed

Mor V, Joyce NR, Coté DL, Gidwani RA, Ersek M, Levy CR, Faricy-Anderson KE, Miller SC, Wagner TH, Kinosian BP, Lorenz KA, Shreve ST (2016) The rise of concurrent care for veterans with advanced cancer at the end of life. Cancer 122:782–790. https://doi.org/10.1002/cncr.29827 CrossRefPubMed

Harrison KL, Connor SR (2016) First Medicare demonstration of concurrent provision of curative and hospice services for end-of-life care. Am J Public Health 106:1405–1408. https://doi.org/10.2105/AJPH.2016.303238 CrossRefPubMedPubMedCentral

U.S. Centers for Medicare & Medicaid Services (2015) Medicare care choices model enables concurrent palliative and curative care. J Pain Palliat Care Pharmacother 29:401–403. https://doi.org/10.3109/15360288.2015.1103358 CrossRef

10.

Salz T, Brewer NT (2009) Offering chemotherapy and hospice jointly: one solution to hospice underuse. Med Decis Mak 29:521–531. https://doi.org/10.1177/0272989X09333123 CrossRef

11.

Toy E, Macbeth F, Coles B, Melville A, Eastwood A (2003) Palliative thoracic radiotherapy for non-small-cell lung cancer: a systematic review. Am J Clin Oncol 26:112–120CrossRefPubMed

12.

Coy P, Schaafsma J, Schofield JA (2000) The cost-effectiveness and cost-utility of high-dose palliative radiotherapy for advanced non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 48:1025–1033CrossRefPubMed

13.

Billingham LJ, Bathers S, Burton A, Bryan S, Cullen MH (2002) Patterns, costs and cost-effectiveness of care in a trial of chemotherapy for advanced non-small cell lung cancer. Lung Cancer 37:219–225CrossRefPubMed

14.

Dooms CA, Lievens YN, Vansteenkiste JF (2006) Cost-utility analysis of chemotherapy in symptomatic advanced nonsmall cell lung cancer. Eur Respir J 27:895–901. https://doi.org/10.1183/09031936.06.00102705 CrossRefPubMed

15.

Rickerson E, Harrold J, Kapo J, Carroll JT, Casarett D (2005) Timing of hospice referral and families’ perceptions of services: are earlier hospice referrals better? J Am Geriatr Soc 53:819–823. https://doi.org/10.1111/j.1532-5415.2005.53259.x CrossRefPubMed

16.

Saito AM, Landrum MB, Neville BA, Ayanian JZ, Weeks JC, Earle CC (2011) Hospice care and survival among elderly patients with lung cancer. J Palliat Med 14:929–939. https://doi.org/10.1089/jpm.2010.0522 CrossRefPubMedPubMedCentral

17.

Sullivan DR, Ganzini L, Lapidus JA, Hansen L, Carney PA, Osborne ML, Fromme EK, Izumi S, Slatore CG (2018) Improvements in hospice utilization among patients with advanced-stage lung cancer in an integrated health care system. Cancer 124:426–433. https://doi.org/10.1002/cncr.31047 CrossRefPubMed

18.

Vig EK, Starks H, Taylor JS, Hopley EK, Fryer-Edwards K (2010) Why don’t patients enroll in hospice? Can we do anything about it? J Gen Intern Med 25:1009–1019. https://doi.org/10.1007/s11606-010-1423-9 CrossRefPubMedPubMedCentral

19.

Allison RD, Tong X, Moorman AC, Ly KN, Rupp L, Xu F, Gordon SC, Holmberg SD, Chronic Hepatitis Cohort Study (CHeCS) Investigators (2015) Increased incidence of cancer and cancer-related mortality among persons with chronic hepatitis C infection, 2006-2010. J Hepatol 63:822–828. https://doi.org/10.1016/j.jhep.2015.04.021 CrossRefPubMedPubMedCentral

20.

Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM (2014) Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 74:2913–2921. https://doi.org/10.1158/0008-5472.CAN-14-0155 CrossRefPubMed

21.

Zullig LL, Sims KJ, McNeil R, Williams CD, Jackson GL, Provenzale D, Kelley MJ (2017) Cancer incidence among patients of the U.S. veterans affairs health care system: 2010 update. Mil Med 182:e1883–e1891. https://doi.org/10.7205/MILMED-D-16-00371 CrossRefPubMedPubMedCentral

22.

Pruchno R (2016) Veterans aging. Gerontologist 56:1–4. https://doi.org/10.1093/geront/gnv671 CrossRefPubMed

23.

Bluethmann SM, Mariotto AB, Rowland JH (2016) Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomark Prev 25:1029–1036. https://doi.org/10.1158/1055-9965.EPI-16-0133 CrossRef

24.

Gidwani-Marszowski R, Needleman J, Mor V, Faricy-Anderson K, Boothroyd DB, Hsin G, Wagner TH, Lorenz KA, Patel MI, Joyce VR, Murrell SS, Ramchandran K, Asch SM (2018) Quality of end-of-life care is higher in the VA compared to care paid for by traditional Medicare. Health Aff 37:95–103. https://doi.org/10.1377/hlthaff.2017.0883 CrossRef

25.

Ersek M, Miller SC, Wagner TH, Thorpe JM, Smith D, Levy CR, Gidwani R, Faricy-Anderson K, Lorenz KA, Kinosian B, Mor V (2017) Association between aggressive care and bereaved families’ evaluation of end-of-life care for veterans with non-small cell lung cancer who died in Veterans Affairs facilities. Cancer 123:3186–3194. https://doi.org/10.1002/cncr.30700 CrossRefPubMed

26.

Hoffer Gittell J (2002) Coordinating mechanisms in care provider groups: relational coordination as a mediator and input uncertainty as a moderator of performance effects. Manag Sci 48:1408–1426. https://doi.org/10.1287/mnsc.48.11.1408.268 CrossRef

27.

Gittell JH (2015) How interdependent parties build relational coordination to achieve their desired outcomes. Negot J 31:387–391. https://doi.org/10.1111/nejo.12114 CrossRef

28.

Gittell JH (2015) Supervisory span, relational coordination, and flight departure performance: a reassessment of postbureaucracy theory. Organ Sci 12:468–483. https://doi.org/10.1017/CBO9781107415324.004 CrossRef

29.

Havens DS, Vasey J, Gittell JH, Lin WT (2010) Relational coordination among nurses and other providers: impact on the quality of patient care. J Nurs Manag 18:926–937. https://doi.org/10.1111/j.1365-2834.2010.01138.x CrossRefPubMed

30.

Gittell JH, Weinberg D, Pfefferle S, Bishop C (2008) Impact of relational coordination on job satisfaction and quality outcomes: a study of nursing homes. Hum Resour Manag J 18:154–170. https://doi.org/10.1111/j.1748-8583.2007.00063.x CrossRef

31.

Gittell JH, Godfrey M, Thistlethwaite J (2012) Interprofessional collaborative practice and relational coordination: improving healthcare through relationships. J Interprof Care 27:210–213. https://doi.org/10.3109/13561820.2012.730564 CrossRefPubMed

32.

Creswell JW, Plano Clark VL (2011) Designing and conducting mixed methods research, 2nd edn. Sage, Thousand Oaks, CA

33.

Polkinghorne D (2005) Language and meaning: data collection in qualitative research. J Couns Psychol 52:127–145CrossRef

34.

Creswell JW (2012) Qualitative inquiry and research design: choosing among five approaches, 3rd edition. Sage, Thousand Oaks, CA

35.

Creswell JW (2014) Research design: qualitative, quantitative, and mixed methods approaches, 4th edition. Sage, Thousand Oaks, CA

36.

Hesse-Biber S, Leavy PL (2010) The practice of qualitative research, second edition. Sage, Thousand Oaks, CA

37.

Jones J, Nowels C, Sudore R, Ahuwalia S, Bekelman D (2015) The future as a series of transitions: qualitative study of heart failure patients and their informal caregivers. J Gen Intern Med 30(2):176–182. https://doi.org/10.1007/s11606-014-3085-5 CrossRefPubMed

38.

Patton MQ (2014) Qualitative research & evaluation methods: integrating theory and practice, 4th edition. Sage, Thousand Oaks, CA

39.

Morgan DL (2010) Reconsidering the role of interaction in analyzing and reporting focus groups. Qual Health Res 20:718–722. https://doi.org/10.1177/1049732310364627 CrossRefPubMed

40.

Atlas.ti [computer program] Version 7.5.2. (2014) Archive for Technology, Lifeworld and Everyday Language. Berlin, Germany

41.

Centers for Medicare & Medicaid Services (2015) Coverage of hospice services under hospital insurance. Medicare Benefit Policy Man. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c09.pdf. Accessed 29 April 2018

42.

Chabowski M, Polański J, Mazur G, Janczak D, Rosińczuk J (2017) Sociodemographic and clinical determinants of quality of life of patients with non-small cell lung cancer. Adv Exp Med Biol 1022:1–10. https://doi.org/10.1007/5584_2017_36 CrossRefPubMed

Title: The experience of providing hospice care concurrent with cancer treatment in the VA
Authors: Leah M. Haverhals
Chelsea E. Manheim
Vincent Mor
Mary Ersek
Bruce Kinosian
Karl A. Lorenz
Katherine E. Faricy-Anderson
Risha A. Gidwani-Marszowski
Cari Levy
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 4/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-018-4552-z

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2019

Timing flexibility of oral NEPA, netupitant-palonosetron combination, administration for the prevention of chemotherapy-induced nausea and vomiting (CINV)

Urine cultures at the onset of febrile neutropenia rarely impact antibiotic management in asymptomatic adult cancer patients

Clinical and sociodemographic factors that may influence the resilience of women surviving breast cancer: cross-sectional study

Enhancing behavioral change among lung cancer survivors participating in a lifestyle risk reduction intervention: a qualitative study

Modeling symptom drivers of oral intake in long-term head and neck cancer survivors

G-CSF guideline adherence in Germany, an update with a retrospective and representative sample survey

Keynote webinar | Spotlight on antibody–drug conjugates in cancer