• Nancy E Morden, Chiang-Hua Chang, Joseph O Jacobson, Ethan M Berke, Julie P W Bynum, Kimberly M Murray, and David C Goodman.
• Dartmouth Medical School, Lebanon, New Hampshire, USA. nancy.e.morden@dartmouth.edu
• Health Aff (Millwood). 2012 Apr 1; 31 (4): 786-96.

AbstractStudies have shown that cancer care near the end of life is more aggressive than many patients prefer. Using a cohort of deceased Medicare beneficiaries with poor-prognosis cancer, meaning that they were likely to die within a year, we examined the association between hospital characteristics and eleven end-of-life care measures, such as hospice use and hospitalization. Our study revealed a relatively high intensity of care in the last weeks of life. At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit status. We found that these hospital characteristics explained little of the observed variation in intensity of end-of-life cancer care and that none reliably predicted a specific pattern of care. These findings raise questions about what factors may be contributing to this variation. They also suggest that best practices in end-of-life cancer care can be found in many settings and that efforts to improve the quality of end-of-life care should include every hospital category.

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