Hospice Eligibility Criteria Should Be Reconsidered

Cultural differences, economic characteristics may lead to many black cancer patients being excluded from hospice care

TUESDAY, Dec. 23 (HealthDay News) -- Criteria that require cancer patients to end curative treatment before entering hospice care play a role in racial disparities in hospice use, and these criteria may prevent those with the greatest need from receiving hospice services, according to research published online Dec. 23 in Cancer.

Jessica Fishman, Ph.D., of the University of Pennsylvania in Philadelphia, and colleagues analyzed data from 283 patients with cancer who had life expectancy of up to six months if they were to discontinue treatment. Patients reported their needs for five hospice services and reported their preferences for aggressive cancer treatment.

Black patients were more likely to want aggressive treatment than white patients, the investigators found. These individuals also had greater perceived needs for specific hospice services. However, this greater need was largely due to financial differences, the researchers report. Those with the fewest financial resources had the highest need for services, note the authors, who speculate that wealthier patients may purchase services without having to get them from hospice.

"For 25 years, hospice services have been restricted to patients in the last six months of life who are willing to give up curative treatment. Although this restriction was intended to control costs, it has substantially reduced access to hospice for many patients who have needs for hospice services, and a disproportionate number of these patients are African American. This eligibility criterion should be reconsidered, and needs-based criteria should be considered to make hospice eligibility criteria both fairer and more consistent with eligibility criteria for other health insurance benefits," the authors conclude.

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