This research suggests that regions and hospitals where cancer patients are hospitalized more often in the last month of life, receive more aggressive treatment in their last month and spend relatively few days in hospice are signs that patients are receiving treatment that they do not want.
The wide variation found in end-of-life cancer care can be explained only partly by patient preferences. Because differences in patients' age, sex, race, income and illness have been adjusted for, the variation that remains is caused by other factors, such as the availability of medical resources and the practice styles of health systems and clinicians.
The research in this report has important implications for clinicians, hospitals, policymakers, and patients in California. Providers can see how their organizations and regions compare with others, and consider ways to provide less-costly care that is more closely aligned with patient wishes. Policymakers can identify regions and hospitals that are using promising approaches - as well as those that may benefit from more support in improving end-of-life care. Finally, patients can choose their caregivers and their site of care, and make their specific wishes known to their children.