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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Thursday, June 28, 2007

When hospice care is 'too late'

By Elizabeth Cooney, Globe Correspondent

About 12 percent of Massachusetts family members said their loved ones entered hospice care too late, resulting in less satisfaction with their care, according to a national survey.

The survey also found that the number of days people spent in hospice care affected satisfaction levels less than whether they got that care too late.

Brown University researchers report in the Journal of Pain and Symptom Management that 11.4 percent of respondents thought their relatives received hospice care too late. In Massachusetts, the figure was 12.6 percent. Vermont had the lowest rate, at 7.8 percent, and South Carolina had the highest, 15 percent.

There was a strong association between people who said their loved ones were referred to hospice too late and also reported dissatisfaction with the quality of care. The researchers expected this to be true for the shortest stays, but even referrals to hospice two days before death were called "the right time" by three-quarters of the relatives.

"We firmly believed, in our hearts and souls, that people of short length of stay were going to have greater unmet needs, more concerns and more dissatisfaction," lead author Dr. Joan M. Teno said in an interview. "Much to my surprise, the opposite is true."

Among people whose relatives had only two days of hospice care, only 24 percent said that was too late. Teno said she would have expected a much higher rate.

"I think this relates to how well hospice programs rally the troops to make everything happen," she said. "The entire hospice team mobilizes very quickly. They go in there and they do a very intensive intervention for the last 24 or 48 hours."

Hospice experts say that dying people and their families benefit the most when they receive hospice care for at least three months, but the average stay lasts less than two months. Thirty percent of hospice patients die in seven days or fewer, according to the National Hospice and Palliative Care Organization, which worked with the Brown researchers to survey more than 100,000 families from 631 hospices.

Posted by Elizabeth Cooney at 04:04 PM
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