Outpatient end of life discussions shorten hospital admissions in gynecologic oncology patients

Gynecol Oncol. 2013 Jul;130(1):152-5. doi: 10.1016/j.ygyno.2013.03.020. Epub 2013 Mar 29.


Objective: The study goal was to determine whether prior outpatient exposure to hospice discussion altered the inpatient course and end-of-life (EOL) care among patients ultimately discharged to hospice.

Methods: Medical records from January 2009 to June 2012 were reviewed and data were abstracted under an IRB-approved protocol. Hospice discussions were identified in the last outpatient clinical encounter prior to admission. Kaplan-Meier was used to estimate overall survival (OS) and the log-rank test was used to test for differences.

Results: There were 89 hospitalizations resulting in discharge to hospice care: 41 women with ovarian (46%), 23 with uterine (29%), 19 with cervical (21.3%), and with 6 vulvar/vaginal (6.7%) cancers. 83 patients (93%) had outpatient clinical encounters prior to admission;18% (15/83) were exposed to a hospice discussion (HD) and 82% (68/83) were not (NHD). Median time from last outpatient encounter was 18 days (range 0-371). NHD patients had longer inpatient length of stay (median 7 days vs. 4 days, p=0.008) and were less likely to receive palliative care consults than the HD patients (65% vs. 93%, p=0.03). Median OS for HD patients was 33 days (95% CI 22d-61 d) vs. 60 days (95% CI 49 d-84 d) for NHD patients (p=0.01). There were no differences detected based on race, ethnicity, or insurance status.

Conclusions: HD patients had significantly shorter OS suggesting that providers were accurate in identifying patients nearing the EOL. Patients exposed to outpatient hospice discussions had a shorter length of stay and increased utilization of palliative care resources.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Genital Neoplasms, Female / psychology*
  • Genital Neoplasms, Female / therapy*
  • Hospices / methods
  • Hospices / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Middle Aged
  • Outpatients
  • Proportional Hazards Models
  • Regression Analysis
  • Terminal Care / methods
  • Terminal Care / psychology
  • Terminal Care / statistics & numerical data*