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.