Comments on: Hospice Beats Hospital

By: Overcoming Bias : Beware Cancer Med

Overcoming Bias : Beware Cancer Med — Mon, 23 May 2011 20:21:14 +0000

[...] on cancer patients, those patients die no less, and maybe more. That fits with cancer patients living longer when they go to hospice and get no cancer treatment and with randomized trials of cancer [...]

By: Jane

Jane — Mon, 24 Jan 2011 10:52:09 +0000

Instead of cherry picking subjects for a study, one should do a simple calculation of the average time spent in hospice by patients. The material for one popular hospice stated X patients since inception Y years ago – and the answer was 4 weeks (co-incidentally the Medicare limit).

By: Recovering irrationalist

Recovering irrationalist — Mon, 05 Nov 2007 15:05:41 +0000

(Plus in this case, those getting hospital attention could feel more of a burden than those in hospice, which in an ancestral environment equals consuming more resources usable by grandkids).

By: Recovering irrationalist

Recovering irrationalist — Mon, 05 Nov 2007 14:56:03 +0000

simple acts such as giving nursing home residents control over the care of a potted plant can change the six month death rate from 30% to 15%. Late retirers tend to live longer, people with dependants and even pet owners are more likely to survive many serious illnesses, now this. Peter, on the reverse side, there is a pre print in Cancer that actually shows no correlation between mood/control and outcome in a serious disease (link title: "Emotional well-being does not predict survival in head and neck cancer patients") So maybe feeling happy doesn't help. Maybe feeling useful does. Evolutionary psychology could explain that far better. Is your body programmed to shut down before it has to because your ruthless genes don't want you outliving your usefulness to them, beyond the point you consume more in family resources than you're worth to family fitness? Not just don't care if you live, but would rather you didn't. Does feeling useful in old age counteract this effect? If so, lives could be saved by concentrating specifically on patient perception of usefulness (modeled from an ancestral environment perspective) rather than general mood or activity. Has anyone looked at this? Sorry if I'm being dense. This EvoPsy link does seem too obvious for someone brighter than me not to have spotted before, but I can't find any specific mention.

By: Jor

Jor — Mon, 05 Nov 2007 02:59:29 +0000

Peter, on the reverse side, there is a pre print in Cancer that actually shows no correlation between mood/control and outcome in a serious disease (i.e. late stage cancer). The data from the Cancer publication is from a RCT, and I believe has the most # of events (Deaths) and largest sample of all mood-outcome studies to date.

By: Peter McCluskey

Peter McCluskey — Sun, 04 Nov 2007 15:33:10 +0000

Cody's point makes me think the title ought to have a question mark. We can only guess at the causality. Do hospices provide patients with greater feelings of being in control? The effects of those feelings are much larger than most people realize. Studies by Langer and Rodin show that simple acts such as giving nursing home residents control over the care of a potted plant can change the six month death rate from 30% to 15%.

By: Robin Hanson

Robin Hanson — Sun, 04 Nov 2007 10:38:06 +0000

Gordon, most US hospice patients are reimbursed through Medicare and Medicaid. Charity hospices certainly do ask for such payment. But you are right that they treat patients without such coverage the same. The overall expense for hospices is less than hospitals, but less than a factor of two if I recall.

By: Gordon Worley

Gordon Worley — Sun, 04 Nov 2007 03:47:50 +0000

Eliezer,

Most hospices are run as charitable organizations that do not ask for payment for their services. They provide as much care as needed (at least as far as they have resources to provide such care), regardless of how much money you have. They do ask you to donate, but to the best of my knowledge this is handled by a separate department, so the care personnel don’t know who is paying them.

So to answer your question, hospitals are nearly infinitely more expensive than hospices.

By: Robin Hanson

Robin Hanson — Sat, 03 Nov 2007 22:46:04 +0000

Jor, is there some N years where you think hospice patients have a lower chance of reaching? If so you could do a similar study to see.

By: Jor

Jor — Sat, 03 Nov 2007 21:36:27 +0000

In my limitted experience, its usually patient who don’t want to head towards hospice yet. If anything, every time, I’ve witnessed one of these discussions, with a patient who isn’t ready to give up yet, its repeatedly mentioned that the hospital is a dangerous place, and when you’re approaching end-of-life the therapies remaining are more ad-hoc and definitely more dangerous.

My qualm with the study would be, I don’t think by staying in the hospital you’re trying to increase your mean survival — you’re trying to increase your probability of living to 1 or N years.