Hospice Referral in Advanced Cancer in New Jersey

Bridget L. Nicholson, Linda Flynn, Beth Savage, Peijia Zha, Elissa Kozlov

Research output: Contribution to journalArticlepeer-review


The need for hospice care is increasing in the United States, but insufficient lengths of stay and disparity in access to care continue. Few studies have examined the relationship between the presence of symptoms and hospice referral. The study measured the association between hospice referral and demographic characteristics and the presence of pain and depression in a cohort of people hospitalized with metastatic cancer in New Jersey in 2018. This study was secondary analysis of the 2018 New Jersey State Inpatient Database. The sample was limited to adult patients with metastatic cancer. Descriptive statistics evaluated the composition of the sample. Generalized linear modeling estimated the effect of pain and depression on incidence of hospice referral in a racially and economically diverse population. Absence of pain resulted in lower odds of receiving a referral to hospice upon discharge (adjusted odds ratio [AOR], 0.44; 95% confidence interval [CI], 0.40-0.49; P =.00). Likewise, an absence of depression also resulted in decreased odds of a hospice referral (AOR, 0.85; 95% CI, 0.76-0.96; P =.008). Compared with Whites, Blacks (AOR, 0.86; 95% CI, 0.76-0.97; P =.00) and Hispanics had significantly lower odds of receiving a hospice referral (AOR, 0.84; 95% CI, 0.72-0.96; P =.01). Patients with a primary language other than English, there were significantly lower odds of receiving a hospice referral (AOR, 0.85; 95% CI, 0.73-0.99; P =.03). Patients with pain and depression had increased hospice referrals. Disparities persist in hospice referral, particularly in Black and Hispanic cases and those without a primary language of English.

Original languageEnglish (US)
Pages (from-to)167-174
Number of pages8
JournalJournal of Hospice and Palliative Nursing
Issue number3
StatePublished - Jun 1 2022

All Science Journal Classification (ASJC) codes

  • Community and Home Care
  • Advanced and Specialized Nursing


  • depression
  • hospice
  • pain
  • primary language
  • racial disparities


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