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Dying veterans boost participation in hospice care

Dying veterans boost participation in hospice care
From Reuters - July 14, 2017

(Reuters Health) - An initiative to enroll dying veterans in hospice care appears to be working, and its success may offer clues for how to persuade others who are terminally ill to join the highly lauded end-of-life program, a new study shows.

After the U.S. Veterans Administration implemented its Comprehensive End of Life Care Initiative in 2009, growth of enrollment of terminally ill male war veterans in hospice care outstripped enrollment growth in hospice programs for elderly men who did not serve, according to the report in Health Affairs.

More veterans likely enrolled in hospice care because the initiative allowed them to continue to have curative treatments, said Joanne Spetz, a professor at the Institute for Health Policy Studies at the University of California, San Francisco. Other hospice programs require participants to cease disease-modifying treatment.

Spetz suspects that being able to use both hospice and concurrent care motivated people to sign up for hospice care "because it wasnt an either/or decision, she said in a phone interview.

Deciding to forego chemotherapy, radiation or any other possible curative treatments can be difficult for patients and families, said Spetz, who was not involved in the study.

Theres fear that if I sign up for hospice, Ive given up, she said. Its also hard for the physician, whos trained that death is a loss.

Researchers compared hospice use among more than 1.1 million male veterans ages 65 and older between 2007 and 2014 with more than 140,000 demographically similar Medicare beneficiaries not enrolled in VA healthcare.

By 2011, they found that 44 percent of veterans who died in hospitals took their last breaths in hospice beds, compared to 30 percent in 2008. By 2012, 71 percent of veterans dying of cancer were enrolled in hospice.

Lead author Susan Miller, a professor at the Brown University School of Public Health in Providence, Rhode Island, and her team structured the study to examine whether the VA initiative drove growth beyond that in the general Medicare population.

Before the initiative, veterans were 15 percent less likely than non-veterans to go into hospice, Miller said in a phone interview. Today, theyre 2.4 percent more likely.

The VA initiative focused on increases in palliative and hospice care. By 2012, the VA had installed 54 new hospice and palliative-care inpatient units, the authors write.

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