Spousal Illness Burden Is Associated with Delayed Use of Hospice Care in Terminally Ill Patients

摘要

Patients' families are important in hospice not only because they themselves might benefitfrom it, but also because they influence whether and how hospice is used to begin with. Wehypothesized that, among the married, people with less capable spouses (in this case, thosewho are less healthy) should be less able to use home hospice care and should enroll in hospicelater in the course of their illness, closer to death. We tested this hypothesis by evaluatingthe impact of spousal health on the timing of patients' use of hospice in a select groupof 517 couples, a total of 1034 patients, for whom we have health data for both partners fromMedicare claims records. We evaluated cohort survival using the Kaplan-Meier method andCox regression, and we measured illness burden using the Charlson comorbidity score.Among the probands, 45.6% had a primary cancer diagnosis, 44.5% were female, 7.5% werenonwhite, their mean age was 80.0 years (7.6 SD), and their mean Charlson score was 3.13.0. The probands' median survival after hospice enrollment was 55 days. Spouses were similarlycomposed demographically, but were less likely to have a cancer primary diagnosis(35.4% had cancer) and were slightly younger than the probands; their mean Charlson scorewas 2.92.9. Each additional point in the Charlson score of the spouse, controlling for measuredcharacteristics of the proband, is associated with a 5.1% increase in the risk of death afterenrollment. That is, after controlling for the characteristics of hospice patients themselves,those with sicker spouses are enrolled later. Compared with patients with the healthiestspouses, those with moderately sick and very sick spouses had considerably later enrollmentinto hospice, with the median survival decreasing from 111 to 49 to 22 days across the groups.Our data suggest that there may be a separate role of spousal health in affecting the time ofhospice enrollment, and that patients' social support may affect not just their health status tobegin with, but also their use of health care in general.