Homecare referrals and 12-week outcomes following surgery for cancer

Purpose/Objectives: To determine characteristics of patients undergoing cancer surgery who do and do not receive homecare referral after hospitalization, relative to poor discharge outcomes. Design: Secondary analysis of a randomized clinical trial. Setting: Urban, academic cancer center in the northeastern United States. Sample: 375 patients 60 years and older and admitted for solid tumor cancer surgery. Methods: Stepwise, multiple logistic regression using patient characteristics related to homecare referrals or those related to poor discharge outcomes. Main Research Variables: Homecare referral and poor discharge outcome. Findings: Patients 70 years or older, single, hospitalized for a week or more for a late-stage cancer, with greater than four comorbid conditions, and discharged with more than four daily activity impairments, depressive symptoms, and a need for skilled nursing care were more likely to require home care. Patients not referred to home care who received adjuvant cancer therapies were about three times more likely to have poor discharge outcomes. Conclusions: Patients who were referred for home care had characteristics similar to medical or surgical patients documented in the literature. However, younger patients with lengthy hospital stays and recipients of adjuvant cancer therapy did poorly after discharge and may benefit from home care. Implications for Nursing: Certain characteristics, such as age, single marital status, depression, and cognition, should trigger further assessment of patients' needs after discharge, including anticipating needs of patients who will receive adjuvant therapies.