Surviving spouses of patients who received hospice care for three or more days more frequently reported reduced depressive symptoms after the patient’s death compared to spouses of patients who did not receive hospice, according to a study by Icahn School of Medicine at Mount Sinai researchers. The findings were published recently in JAMA Internal Medicine.
Hospice services, which are offered to terminally ill patients, are focused on providing quality-of-life care that may include medical services, symptom management, and spiritual counseling to the patient, as well as bereavement and other counseling services for family members.
This was the first time a national study examined the impact of hospice on patients and their spouses in the setting of a variety of terminal illnesses—not only cancer, as in prior studies—and used data linked to Medicare claims for hospice services to counter recall bias. Hospice care is a standard benefit covered by Medicare and all major health insurers in the United States.
Specifically, researchers analyzed data from 1,016 deceased patients, and their surviving spouses who participated in surveys over a period of years, to assess common depressive symptoms. The surveys were conducted in the years before the death of the patient, through bereavement, and up to two years after.
While researchers found that depressive symptoms increased for the majority of surviving spouses immediately following the death of their loved ones, 28 percent of the surviving spouses of hospice users had fewer symptoms of depression, compared to 22 percent of the spouses of non-hospice users.
The researchers say that while the study was not able to determine which specific aspects of hospice care are associated with the observed improvements, they are encouraged by their conclusions, noting that hospice care has increased by 21 percent in the United States in the last decade.
“The expansion of hospice use in recent years to many patients beyond those with cancer makes the study more timely than ever,” says Katherine Ornstein, PhD, Assistant Professor, Geriatrics and Palliative Medicine, and the study’s lead author. “While previous studies in the cancer population have demonstrated the benefits of hospice for patients and their families, our work shows benefits of hospice for families of patients with all types of serious illness, including dementia and congestive heart failure.”
Based on their findings, the investigators believe families could benefit from earlier supportive interventions. “Additional support is needed for families and caregivers throughout the often long course of serious illness,” says Amy Kelley, MD, Associate Professor, Geriatrics and Palliative Medicine, and senior author of the study.
Adds Diane E. Meier, MD, Director of Mount Sinai’s Center to Advance Palliative Care, and Co-Director of The Patty and Jay Baker National Palliative Care Center: “We need to formalize the process of assessing the needs of family members and caregivers across a wide range of palliative care and clinical settings. We need to recognize that we cannot take care of the patient without taking good care of the family.”