Chua Isaac S, Huskamp Haiden A, Mehrotra Ateev, Wilcock Andrew D
Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
JAMA Netw Open. 2025 Jul 1;8(7):e2522886. doi: 10.1001/jamanetworkopen.2025.22886.
Palliative care (PC) use patterns may have changed in recent years due to increased adoption of telehealth and the availability of more advanced practice clinicians who specialize in PC delivery.
To describe changes in the use of specialty PC during the last year of life among Medicare beneficiaries who had cancers with poor prognoses (cancers that commonly caused death, rare cancers with high mortality rates, or solid tumors with concurrent nonlymphatic metastases; hereinafter termed poor-prognosis cancers).
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study includes all US Medicare fee-for-service beneficiaries who died from poor-prognosis cancers between January 1, 2018, and December 31, 2023, and received care in hospital and outpatient settings.
Encounters with a PC specialist.
The primary outcome was the proportion of decedents with any specialty PC encounter in their last year of life. Secondary outcomes included mean number of PC encounters among decedents with at least 1 encounter with a PC specialist and telehealth use. PC specialists were clinicians who self-identified as a PC specialist or were clinicians with 80% or more of their Medicare encounters focused on PC.
The cohort included 1 508 103 decedents (mean [SD] age, 79.6 [8.0] years; 54.6% male) with poor-prognosis cancers. Between 2018 and 2023, the proportion of decedents with at least 1 PC encounter increased from 29.84% to 37.21% (adjusted change, 7.21 [95% CI, 6.30-8.12] percentage points; relative change, 24.2%). The proportion who received outpatient PC increased from 10.66% to 20.56% (adjusted change, 9.41 [95% CI, 8.33-10.48] percentage points; relative change, 88.2%). In 2023, 22.84% of all decedents received PC from advanced practice clinicians vs 15.60% by self-designated PC physicians and 9.92% by other physicians. Telehealth was used for 18.2% of all outpatient palliative care encounters in 2023. Decedent characteristics associated with not receiving specialty PC included older age, lower income, and living in nonmetropolitan areas.
In this cohort study of decedents who had poor-prognosis cancers, an increasing proportion received any specialty PC. Advanced practice specialists were the most common clinician type who delivered specialty PC, and telehealth was used for a substantial proportion of outpatient visits. Despite these changes, only a minority of patients received specialty PC, and low use of specialty PC among certain subpopulations persisted, suggesting that different strategies are needed to overcome these barriers.
近年来，由于远程医疗的采用增加以及更多专门从事姑息治疗（PC）的高级执业临床医生的出现，姑息治疗的使用模式可能发生了变化。
描述患有预后不良癌症（通常导致死亡的癌症、高死亡率的罕见癌症或伴有非淋巴转移的实体瘤；以下简称预后不良癌症）的医疗保险受益人在生命最后一年中专科姑息治疗的使用变化。
设计、设置和参与者：这项回顾性队列研究包括2018年1月1日至2023年12月31日期间因预后不良癌症死亡且在医院和门诊接受治疗的所有美国医疗保险按服务收费受益人。
与姑息治疗专科医生的接触。
主要结局是在生命最后一年中曾有过任何专科姑息治疗接触的死者比例。次要结局包括至少与一名姑息治疗专科医生有过一次接触的死者的姑息治疗接触平均次数以及远程医疗的使用情况。姑息治疗专科医生是自我认定为姑息治疗专科医生的临床医生，或者是其医疗保险接触中有80%或更多集中在姑息治疗的临床医生。
该队列包括1508103名患有预后不良癌症的死者（平均[标准差]年龄为79.6[8.0]岁；54.6%为男性）。2018年至2023年期间，至少有一次姑息治疗接触的死者比例从29.84%增至37.21%（调整后变化为7.21[95%置信区间，6.30 - 8.12]个百分点；相对变化为24.2%）。接受门诊姑息治疗的比例从10.66%增至20.56%（调整后变化为9.41[95%置信区间，8.33 - 10.48]个百分点；相对变化为88.2%）。2023年，所有死者中有22.84%接受了高级执业临床医生的姑息治疗，而自我认定的姑息治疗医生为15.60%，其他医生为9.92%。2023年远程医疗用于所有门诊姑息治疗接触的比例为18.2%。与未接受专科姑息治疗相关的死者特征包括年龄较大、收入较低以及居住在非大都市地区。
在这项针对患有预后不良癌症死者的队列研究中，接受任何专科姑息治疗的比例在增加。高级执业专科医生是提供专科姑息治疗最常见的临床医生类型，且远程医疗用于相当比例的门诊就诊。尽管有这些变化，但只有少数患者接受了专科姑息治疗，某些亚群体中专科姑息治疗的低使用率仍然存在，这表明需要不同策略来克服这些障碍。
