Journal of Pain and Symptom Management
Volume 42, Issue 4 , Pages 557-564, October 2011

Hospice Referrals and Code Status: Outcomes of Inpatient Palliative Care Consultations Among Asian Americans and Pacific Islanders With Cancer

  • Christina L. Bell, MD, MSc

      Affiliations

    • Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
    • Corresponding Author InformationAddress correspondence to: Christina L. Bell, MD, MSc, 347 N. Kuakini Street, HPM 9, Honolulu, HI 96817, USA.
    • ,
  • Meiko Kuriya, MD

      Affiliations

    • Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Shizuoka, Japan
    • ,
  • Daniel Fischberg, MD, PhD

      Affiliations

    • Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
    • Pain and Palliative Care Department, The Queen's Medical Center, Honolulu, Hawaii, USA

Accepted 25 January 2011. published online 25 April 2011.

Abstract 

Context

Intensive palliative care consultations for plan of care may reduce racial differences in end-of-life care.

Objectives

To compare cancer patients' hospice referrals and code status changes after inpatient palliative care consultations by patient ethnicity and consultation intensity.

Methods

This observational cohort study prospectively recorded data for all adult cancer patients receiving palliative care consultations at the largest teaching hospital in Hawaii from 2005 through 2009. Chi-squared analyses compared hospice referral and code status changes with “Do Not Attempt Resuscitation” by patient characteristics and consultation intensity (more intensive plan of care vs. pain and/or symptom management without plan of care). Multiple logistic regression models analyzed factors associated with hospice referral and code status change.

Results

The 1362 consultations generated 454 (33.3%) hospice referrals and 234 (17.2%) code status changes. Controlling for age, gender, Karnofsky score, and preconsultation hospital days, Asian, Pacific Islander, and “other” ethnicities demonstrated increased likelihood of hospice referral vs. whites (adjusted odds ratios [AORs] 1.46–2.34, P<0.05). Intensive plan-of-care consultations were strongly associated with hospice referral (AOR 3.08, 95% confidence interval [CI] 2.33–4.07, P<0.0001). Controlling for consultation intensity reduced the association between ethnicity and hospice referral (AORs 1.35–2.06, P=0.03, “other” ethnicity; P=nonsignificant, Asian and Pacific Islander). Intensive consultations were strongly associated with code status change (AOR 2.96; 95% CI 2.08–4.22, P<0.0001). Ethnicity was not significantly associated with code status change.

Conclusion

Consultation intensity was the strongest predictor of hospice referrals and code status changes and reduced the ethnic variations associated with hospice referral.

Key Words: Palliative care, hospital care, minority populations, Asian Americans, Pacific Islanders, outcomes, hospice, decision making, resuscitation

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PII: S0885-3924(11)00134-5

doi:10.1016/j.jpainsymman.2011.01.010

Journal of Pain and Symptom Management
Volume 42, Issue 4 , Pages 557-564, October 2011

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