Hospice use among cancer decedents in Alabama, 2002-2005.

INTRODUCTION: Most studies that describe hospice use among cancer patients use the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, which has known limitations. We used vital records data to describe patterns of hospice use among cancer decedents in Alabama. METHODS: To ascertain hospice use, we linked death certificates from 2002 through 2005 for people who died from cancer to listings of deaths reported by hospices. To evaluate accessibility of care, we calculated straight-line distances between decedent residence at death and the hospice providing care. We used these distances to estimate the reach of each hospice and identify the number of hospice nonusers residing in these areas. RESULTS: During the study period, 52.0% of cancer decedents in Alabama received hospice care from 165 hospices. Nearly two-thirds of Alabama counties contain at least 1 hospice. Whites (53.6%) used hospice at a significantly higher rate than blacks (47.0%), but the rate of use was similar for women (53.2%) and men (51.0%). For people who were eligible for Medicare, 53.0% received hospice care. The median distance between decedent's residence and the hospice providing care was 9.8 miles. This distance was slightly shorter for blacks than whites and roughly equal by sex. CONCLUSION: Alabamians use hospice at lower rates than observed elsewhere. Barriers to hospice care in Alabama must be identified and addressed.

The recording of demographic information on death certificates: a national survey of funeral directors.

OBJECTIVE: The authors sought to ascertain the methods used by funeral directors to determine the demographic information recorded on death certificates. METHODS: Standardized questionnaires were administered to funeral directors in five urban locations in the U.S. In addition, personnel on four Indian reservations were interviewed. Study sites were selected for diverse racial/ethnic populations and variability in recording practices; funeral homes were selected by stratified random sampling. RESULTS: Fifty-two percent of responding funeral directors reported receiving no formal training in death certification. Seventy-nine percent of respondents reported finding certain demographic items difficult to complete--26% first specified race as the problematic item, and 25% first specified education. The decedent's race was "sometimes" or "often" determined through personal knowledge of the family by 58% of respondents; 43% reported "sometimes" or "often" determining race by observation. Only three respondents reported that occupation was a problematic item. CONCLUSIONS: The authors recommend that the importance of demographic data and the instructions for data collection be clarified for funeral directors, that standard data collection worksheets be developed, and that training videos be developed.