A randomised controlled trial of hospice care

Abstract

Terminally ill cancer patients at a Veterans Administration hospital were randomly assigned to receive hospice or conventional care. The hospice care was provided both in a special inpatient unit and at home. 137 hospice patients and 110 control patients and their familial care givers (FCGs) were followed until the patient's death. No significant differences were noted between the patient groups in measures of pain, symptoms, activities of daily living, or affect. Hospice patients expressed more satisfaction with the care they received; and hospice patients' FCGs showed somewhat more satisfaction and less anxiety than did those of controls. Hospice care was not associated with a reduced use of hospital inpatient days or therapeutic procedures and was at least as expensive as conventional care.

KIE: A study conducted at a Veterans Administration teaching hospital in West Los Angeles, in which terminally ill cancer patients were randomly assigned to receive hospice or conventional care, suggests that hospice care offers little substantive difference from conventional terminal care in cost or effectiveness. Outcomes were similar for both groups regarding pain, costs, length of hospital stay, survival curves, use of major surgical procedures and chemotherapy, and activities-of-daily-life scores. However, hospice patients experienced significantly less depression and expressed more satisfaction with care. The authors recommend that hospice care should be available as a matter of choice. They conclude that conventional care may have improved because the hospice movement has sensitized practitioners to earlier inadequacies.