Understanding the Utility of Less Than Six-Month Prognosis Using Administrative Data Among U.S. Nursing Home Residents With Cancer
Background: There is a dearth of studies evaluating the utility of reporting prognostication among nursing home (NH) residents with cancer. Objective: To study factors associated with documented less than six-month prognosis, and its relationship with end-of-life (EOL) care quality measures among re...
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| Language: | English |
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Mary Ann Liebert
2024-10-01
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| Series: | Palliative Medicine Reports |
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| Online Access: | https://www.liebertpub.com/doi/10.1089/pmr.2023.0047 |
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| author | Long Vu Siran M. Koroukian Sara L. Douglas Hannah L. Fein David F. Warner Nicholas K. Schiltz Jennifer Cullen Cynthia Owusu Martha Sajatovic Johnie Rose Richard Martin |
| author_facet | Long Vu Siran M. Koroukian Sara L. Douglas Hannah L. Fein David F. Warner Nicholas K. Schiltz Jennifer Cullen Cynthia Owusu Martha Sajatovic Johnie Rose Richard Martin |
| author_sort | Long Vu |
| collection | DOAJ |
| description | Background: There is a dearth of studies evaluating the utility of reporting prognostication among nursing home (NH) residents with cancer. Objective: To study factors associated with documented less than six-month prognosis, and its relationship with end-of-life (EOL) care quality measures among residents with cancer. Methods: The Surveillance, Epidemiology, and End Results linked with Medicare, and the Minimum Data Set databases was used to identify 20,397 NH residents in the United States with breast, colorectal, lung, pancreatic, or prostate cancer who died between July 2016 and December 2018. Of these, 2205 residents (10.8%) were documented with less than six-month prognosis upon NH admission. Main outcomes were more than one hospitalization, more than one emergency department visit, and any intensive care unit admission within the last 30 days of life as aggressive EOL care markers, as well as admission to hospice, receipt of advance care planning and palliative care, and survival. Specificity and sensitivity of prognosis were assessed using six-month mortality as the outcome. Propensity score matching adjusted for selection biases, and logistic regression examined association. Results: Specificity and sensitivity of documented less than six-month prognosis for mortality were 94.2% and 13.7%, respectively. Residents with documented less than six-month prognosis had greater odds of being admitted to hospice than those without (adjusted odds ratio: 3.27, 95% confidence interval: 2.86–3.62), and lower odds to receive aggressive EOL care. Conclusion: In this cohort study, documented less than six-month prognosis was associated with less aggressive EOL care. Despite its high specificity, however, low sensitivity limits its utility to operationalize care on a larger population of residents with terminal illness. |
| format | Article |
| id | doaj-art-0b0cc758cef347a99f5fb3a7971a8818 |
| institution | OA Journals |
| issn | 2689-2820 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Mary Ann Liebert |
| record_format | Article |
| series | Palliative Medicine Reports |
| spelling | doaj-art-0b0cc758cef347a99f5fb3a7971a88182025-08-20T02:30:49ZengMary Ann LiebertPalliative Medicine Reports2689-28202024-10-015112713510.1089/pmr.2023.0047Understanding the Utility of Less Than Six-Month Prognosis Using Administrative Data Among U.S. Nursing Home Residents With CancerLong Vu0Siran M. Koroukian1Sara L. Douglas2Hannah L. Fein3David F. Warner4Nicholas K. Schiltz5Jennifer Cullen6Cynthia Owusu7Martha Sajatovic8Johnie Rose9Richard Martin10Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA.Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.The Breen School of Nursing and Health Professions, Ursuline College, Pepper Pike, Ohio, USA.Background: There is a dearth of studies evaluating the utility of reporting prognostication among nursing home (NH) residents with cancer. Objective: To study factors associated with documented less than six-month prognosis, and its relationship with end-of-life (EOL) care quality measures among residents with cancer. Methods: The Surveillance, Epidemiology, and End Results linked with Medicare, and the Minimum Data Set databases was used to identify 20,397 NH residents in the United States with breast, colorectal, lung, pancreatic, or prostate cancer who died between July 2016 and December 2018. Of these, 2205 residents (10.8%) were documented with less than six-month prognosis upon NH admission. Main outcomes were more than one hospitalization, more than one emergency department visit, and any intensive care unit admission within the last 30 days of life as aggressive EOL care markers, as well as admission to hospice, receipt of advance care planning and palliative care, and survival. Specificity and sensitivity of prognosis were assessed using six-month mortality as the outcome. Propensity score matching adjusted for selection biases, and logistic regression examined association. Results: Specificity and sensitivity of documented less than six-month prognosis for mortality were 94.2% and 13.7%, respectively. Residents with documented less than six-month prognosis had greater odds of being admitted to hospice than those without (adjusted odds ratio: 3.27, 95% confidence interval: 2.86–3.62), and lower odds to receive aggressive EOL care. Conclusion: In this cohort study, documented less than six-month prognosis was associated with less aggressive EOL care. Despite its high specificity, however, low sensitivity limits its utility to operationalize care on a larger population of residents with terminal illness.https://www.liebertpub.com/doi/10.1089/pmr.2023.0047cancerend-of-life carenursing homeprognostication |
| spellingShingle | Long Vu Siran M. Koroukian Sara L. Douglas Hannah L. Fein David F. Warner Nicholas K. Schiltz Jennifer Cullen Cynthia Owusu Martha Sajatovic Johnie Rose Richard Martin Understanding the Utility of Less Than Six-Month Prognosis Using Administrative Data Among U.S. Nursing Home Residents With Cancer Palliative Medicine Reports cancer end-of-life care nursing home prognostication |
| title | Understanding the Utility of Less Than Six-Month Prognosis Using Administrative Data Among U.S. Nursing Home Residents With Cancer |
| title_full | Understanding the Utility of Less Than Six-Month Prognosis Using Administrative Data Among U.S. Nursing Home Residents With Cancer |
| title_fullStr | Understanding the Utility of Less Than Six-Month Prognosis Using Administrative Data Among U.S. Nursing Home Residents With Cancer |
| title_full_unstemmed | Understanding the Utility of Less Than Six-Month Prognosis Using Administrative Data Among U.S. Nursing Home Residents With Cancer |
| title_short | Understanding the Utility of Less Than Six-Month Prognosis Using Administrative Data Among U.S. Nursing Home Residents With Cancer |
| title_sort | understanding the utility of less than six month prognosis using administrative data among u s nursing home residents with cancer |
| topic | cancer end-of-life care nursing home prognostication |
| url | https://www.liebertpub.com/doi/10.1089/pmr.2023.0047 |
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