Clinical Topics

Use of Hospice During Treatment Has Limited VA Use

by U.S. Medicine

February 19, 2019

AURORA, CO–Unlike in most private sector settings, veterans with advanced cancer can receive hospice care concurrently with treatments such as radiation and chemotherapy.

A study in Supportive Care in Cancer found that variations exist in concurrent care use across VAMCs and that, overall, concurrent care use is relatively rare.1

Researchers from the Rocky Mountain Regional VAMC and the University of Colorado Downtown Campus sought to identify, describe and explain factors that influence the provision of concurrent cancer care–defined as chemotherapy or radiation treatments provided with hospice–for veterans with terminal cancer.

From August 2015 to April 2016, researchers conducted six site visits and interviewed 76 clinicians and staff at six VA sites and their contracted community hospice about the issue. Information was gathered from staff at 16 community hospices, 25 VA oncology departments, 17 VA palliative care centers and 18 VA inpatient hospice and palliative care units.

Thematic qualitative content analysis found three themes that influenced the provision of concurrent care:

  • Clinicians and staff at community hospices and at VAs viewed concurrent care as a viable care option, as it preserved hope and relationships while patient goals are clarified during transitions to hospice;
  • The presence of dedicated liaisons facilitated care coordination and education about concurrent care; and
  • Clinicians and staff concerns about Medicare guideline compliance hindered use of concurrent care, however.

“While concurrent care is used by a small number of veterans with advanced cancer, VA staff valued having the option available and as a bridge to hospice,” study authors concluded. “Hospice staff felt concurrent care improved care coordination with VAMCs, but use may be tempered due to concerns related to Medicare compliance.”

1. Haverhals LM, Manheim CE, Mor V, Ersek M, Kinosian B, Lorenz KA, Faricy-Anderson KE, Gidwani-Marszowski RA, Levy C. The experience of providing hospice care concurrent with cancer treatment in the VA. Support Care Cancer. 2018 Nov 22. doi: 10.1007/s00520-018-4552-z. [Epub ahead of print] PubMed PMID: 30467792.

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