Palliative Care Program Characteristics and End-of-Life Outcomes for Patients with Metastatic Cancer.

Abstract

Context: Although U.S. palliative care programs have substantial differences in their implementation, whether this heterogeneity impacts patient outcomes is unknown.

Objectives: To determine if palliative care program characteristics are associated with differences in end-of-life quality metrics for patients with metastatic cancer.

Methods: Retrospective cohort study of patients with metastatic cancer who received care from programs that participated in the National Palliative Care Registry, 2018-2019. Multilevel regression was used to examine the association between individual program characteristics and outcomes including use of hospice, hospice enrollment ≥ 3 days, use of intensive care (ICU) in the last 30 days of life, and use of chemotherapy in the last 14 days of life.

Results: The cohort was comprised of 33,015 patients who received care from 235 palliative care programs. Program maturity was the only characteristic associated with a difference in any outcome. Patients who received care from mature programs were more likely to use hospice (adjusted hazard ratio (aHR) 1.15 [1.06-1.25], for 5-10 years vs. < 5 years; aHR 1.18 [1.09-1.29] for > 10 years vs. < 5 years), and were also more likely to have hospice enrollment ≥ 3 days (aHR 1.18 [1.08-1.31] for 5 - 10 years vs. < 5 years; aHR 1.22 [1.11-1.34] for > 10 years vs.< 5 years).

Conclusion: Palliative care program characteristics largely were not associated with differences in end-of-life quality metrics for patients with metastatic cancer. Further work is needed to better understand why program maturity may be associated with improved outcomes.