The experience of providing hospice care concurrent with cancer treatment in the VA

Supportive Care in Cancer volume 27, pages1263–1270(2019)Cite this article

Abstract

Purpose

Veterans with advanced cancer can receive hospice care concurrently with treatments such as radiation and chemotherapy. However, variations exist in concurrent care use across Veterans Affairs (VA) medical centers (VAMCs), and overall, concurrent care use is relatively rare. In this qualitative study, we aimed 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.

Methods

From August 2015 to April 2016, we conducted six site visits and interviewed 76 clinicians and staff at six VA sites and their contracted community hospices, including community hospices (n = 16); VA oncology (n = 25); VA palliative care (n = 17); and VA inpatient hospice and palliative care units (n = 18).

Results

Thematic qualitative content analysis found three themes that influenced the provision of concurrent care: (1) 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; and (2) the presence of dedicated liaisons facilitated care coordination and education about concurrent care; however, (3) clinicians and staff concerns about Medicare guideline compliance hindered use of concurrent care.

Conclusions

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. Hospice staff felt concurrent care improved care coordination with VAMCs, but use may be tempered due to concerns related to Medicare compliance.

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Notes

  1. 1.

    This reflects the Hospice Election language: “The individual’s or representative’s (as applicable) acknowledgment that the individual has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment” [41].

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Funding

This research was funded by the Department of Veterans Affairs Health Services Research and Development grant number 11R 12-121.

Author information

Affiliations

  1. Rocky Mountain Regional Veterans Affairs Medical Center, Denver-Seattle Center of Innovation, Aurora, CO, USA

    Leah M. Haverhals, Chelsea E. Manheim & Cari Levy

  2. Department of Health & Behavioral Sciences, University of Colorado Downtown Campus, Denver, CO, USA

    Leah M. Haverhals

  3. Center of Innovation, Providence Veterans Health Administration (VA) Medical Center, Providence, RI, USA

    Vincent Mor & Katherine E. Faricy-Anderson

  4. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA

    Vincent Mor

  5. Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA

    Mary Ersek & Bruce Kinosian

  6. National Performance Reporting and Outcomes Measurement to Improve the Standard of Care at End-of-Life (PROMISE) Center, US Department of Veterans Affairs, Washington, DC, USA

    Mary Ersek

  7. College of Nursing, University of Pennsylvania, Philadelphia, PA, USA

    Mary Ersek

  8. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Bruce Kinosian

  9. Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA

    Karl A. Lorenz & Risha A. Gidwani-Marszowski

  10. School of Medicine, Stanford University, Stanford, CA, USA

    Karl A. Lorenz & Risha A. Gidwani-Marszowski

  11. Warren Alpert Medical School of Brown University, Providence, RI, USA

    Katherine E. Faricy-Anderson

  12. VA Health Economics Resource Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA

    Risha A. Gidwani-Marszowski

  13. School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Cari Levy

Authors
  1. Leah M. Haverhals
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  2. Chelsea E. Manheim
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  3. Vincent Mor
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Correspondence to Leah M. Haverhals.

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We do not have a financial relationship with the funder, Department of Veterans Affairs Research and Development. This funding was in the form of a grant that was applied for and rewarded. We have full control of all primary data we collected ourselves and analyzed ourselves in this study, and we will allow the journal to review our data upon request.

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The authors declare that they have no conflict of interest.

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Haverhals, L.M., Manheim, C.E., Mor, V. et al. The experience of providing hospice care concurrent with cancer treatment in the VA. Support Care Cancer 27, 1263–1270 (2019). https://doi.org/10.1007/s00520-018-4552-z

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Keywords

  • Concurrent care
  • Veterans
  • Cancer
  • Hospice
  • Palliative care