Palliative Care Laws Influence the Likelihood of Dying at Home or in Hospice

The location of place of death from cancer in the US was associated with the presence of state palliative care laws, according to the findings of a recent study. The results were reported in the journal JAMA Network Open.

“In this study examining the association between palliative care legislation and place of death, we observed that dying in state-years with a palliative care law was associated with a small to moderate increase in the likelihood of dying at home or in hospice for decedents from cancer,” the study investigators wrote in their report.

In this study, state palliative care legislation data were evaluated in conjunction with data from death certificates available through the US National Center for Health Statistics from the dates of January 1, 2005, to December 31, 2017, for decedents with cancer as the underlying cause of death. All 50 US states were included in the analysis, but the District of Columbia was not included. The primary study outcome was dying at home or in hospice, according to the place of death associated with a death certificate. Outcomes were calculated in terms of state-years with or without palliative care laws.

A total of 7,547,907 decedents who had cancer as their underlying cause of death were evaluated in this study. They had a mean age of 71 years (SD, 14). Approximately half (50.1%) of the decedents in the analysis died at home or in hospice. Across the study period, there were 553 state-years (85.1%) without a palliative care law, compared with 37 state-years (5.7%) with a prescriptive palliative care law and 60 state-years (9.2%) with a nonprescriptive palliative care law.

Prescriptive law is defined as requiring clinicians to offer information about care options. Nonprescriptive law is defined as palliative and end-of-life care without prescribing clinician actions.

The majority (70.8%) of deaths occurred in state-years lacking a palliative care law, compared with 13.5% occurring in state-years with a prescriptive palliative care law and 15.7% occurring in state-years with a nonprescriptive palliative care law.

In analyses adjusted for possible confounders, the researchers found that patients with cancer had a likelihood of dying at home or in hospice that was 18% higher for those in state-years with a prescriptive palliative care law (adjusted relative risk, 1.18; 95% CI, 1.11-1.26), compared with state-years lacking a palliative care law. This likelihood was 12% higher for those in state-years with a nonprescriptive palliative care law (adjusted relative risk, 1.12; 95% CI, 1.08-1.16), compared with state-years lacking a palliative care law. Additional analyses of rates for patients with noncancer deaths also suggested higher relative risks of dying at home or in hospice in state-years with prescriptive or nonprescriptive palliative care laws, compared with state-years lacking a palliative care law.

“Our findings suggest that palliative care legislation at the state level could be an effective intervention to increase the number of patients with serious illness who experience their death in such locations,” the investigators concluded in their report.

Reference

Quan Vega ML, Chihuri ST, Lackraj D, Murali KP, Li G, Hua M. Place of death from cancer in us states with vs without palliative care laws. JAMA Netw Open. 2023;6(6):e2317247. doi:10.1001/jamanetworkopen.2023.17247