Predictors of Withdrawal from Hospice

CONTEXT: Hospice is designed to provide end-of-life care to patients who are terminally ill. However, some patients withdraw from hospice even though they are medically eligible. Little is known about these patients, and the factors associated with their withdrawal have not been described. OBJECTIVES: To identify predictors of withdrawal from hospice in a diverse cohort of hospice patients who are eligible to receive service. DESIGN: Retrospective cohort study. PATIENTS AND SETTING: Between January 1997 and January 1999 1,691 patients enrolled in an urban, nonprofit hospice program were identified and data were gathered until discharge or death. MAIN OUTCOME MEASURES: Time to discharge of eligible patients from hospice. RESULTS: Over the study period, 15% of patients were discharged from hospice while they still met medical eligibility criteria. Patients were more likely to withdraw if they were male, unmarried, and younger than 65, if they did not have cancer, and if they lacked a do-not-resuscitate order, intravenous access, and symptoms requiring intervention. CONCLUSIONS: A substantial proportion of hospice patients who meet medical criteria for services choose to withdraw. Further research is needed to define more clearly the reasons for withdrawal and to investigate whether withdrawal is consistent with patient preferences.