Journal Club

Homecare Referrals and 12-Week Outcomes Following Surgery for Cancer

Kathryn H. Bowles

Ruth McCorkle

Isaac F. Nuamah

home management, outpatient setting, postoperative, postdischarge
ONF 2008, 35(3), 377-383. DOI: 10.1188/08.ONF.377-383

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.

Jump to a section


    Beahrs, O. H., Henson, R., Hutter, J., & Kennedy, A. (Eds.). (1992). Manual for staging of cancer (4th ed.). Philadelphia: Lippincott Williams and Wilkins.
    Benoliel, J. G., McCorkle, R., & Young, K. (1980). Development of a social dependency scale. Research in Nursing and Health Care, 3(1), 3-10.
    Bowles, K. H., Foust, J. B., & Naylor, M. D. (2003). Hospital discharge referral decision making: A multidisciplinary perspective. Applied Nursing Research, 16(3), 134-143.
    Bowles, K. H., Naylor, M. D., & Foust, J. B. (2002). Patient characteristics at hospital discharge and a comparison of home care referral decisions. Journal of the American Geriatrics Society, 50(2), 336-342.
    Bowles, K. H., Ratcliffe, S. J., Holmes, J. H., Liberatore, M., Nydick, R., & Naylor, M. D. (2008). Post-acute referral decisions made by multidisciplinary experts compared to hospital clinicians and the patients' 12-week outcomes. Medical Care, 42(2), 158-166.
    Callahan, C. M., Hui, S. L., Nienaber, N. A., Musick, B. S., & Tierney, W. M. (1994). Longitudinal study of depression and health services use among elderly primary care patients. Journal of the American Geriatrics Society, 42(8), 833-838.
    Centers for Medicare and Medicaid Services. (2001). Health care financing review: Medicare and Medicaid statistical supplement. Baltimore, MD: Author.
    Centers for Medicare and Medicaid Services. (2007). Home health agency manual. Chapter II coverage of services. Retrieved September 28, 2007, from
    Clemens, E. L., & Hayes, H. E. (1997). Assessing and balancing elder risk, safety, and autonomy: Decision-making practices of health care professionals. Home Health Care Services Quarterly, 16(3), 3-20.
    Dennis, L. I., Blue, C. L., Stahl, S. M., Benge, M. E., & Shaw, C. J. (1996). The relationship between hospital readmissions of Medicare beneficiaries with chronic illnesses and home care nursing interventions. Home Healthcare Nurse, 14(4), 303-309.
    Estes, C. L., & Swan, J. H. (1993). Long-term care crisis: Elders trapped in the no-care zone. Newbury Park, CA: Sage.
    Evans, R. L., & Hendricks, R. D. (1993). Evaluating hospital discharge planning: A randomized clinical trial. Medical Care, 31(4), 358-370.
    Freiman, M. P., & Breen, N. (1997). The use of home care by cancer patients: A multivariate analysis. Home Health Care Services Quarterly, 16(1-2), 3-19.
    Furstenberg, A. L., & Mezey, M. D. (1987). Mental impairment of elderly hospitalized hip fracture patients. Comprehensive Gerontology, Section B, Behavioural, Social, and Applied Sciences, 1(2), 80-85.
    Garrard, J., Dowd, B. E., Dorsey, B., & Shapiro, J. (1987). A checklist to assess the need for home health care: Instrument development and validation. Public Health Nursing, 4(4), 212-218.
    Gornik, I., Gornik, O., & Gasparovic, V. (2007). HbA1c is outcome predictor in diabetic patients with sepsis. Diabetes Research and Clinical Practice, 77(1), 120-125.
    Hauck, W. W., & Miike, R. (1991). A proposal for examining and reporting stepwise regressions. Statistics in Medicine, 10(5), 711-715.
    Health Care Financing Administration. (1992). Report of the secretary's advisory panel on the development of Uniform Needs Assessment Instrument(s). Washington, DC: U. S. Government Printing Office.
    Hoffman, M. A., & Weiner, J. S. (2007). Is Mrs. S depressed? Diagnosing depression in the cancer patient. Journal of Clinical Oncology, 25(19), 2853-2856.
    Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression. New York: John Wiley and Sons.
    Kane, R. L. (1994). A study of postacute care: Final report, Institute for Health Services Research. Minneapolis: University of Minnesota.
    Kramer, A. (2006). Uniform patient assessment for postacute care. Final report. Aurora, CO: Division of Health Care Policy and Research, University of Colorado at Denver and Health Sciences Center.
    Liu, K., Long, S. K., & Dowling, K. (2003). Medicare interim payment system's impact on Medicare home health utilization. Health Care Financing Review, 25(1), 81-97.
    Locher, J. L., Kilgore, M. L., Morrisey, M. A., & Ritchie, C. S. (2006). Patterns and predictors of home health and hospice use by older adults with cancer. Journal of the American Geriatrics Society, 54(8), 1206-1211.
    Lynch, M. E. (1995). The assessment and prevalence of affective disorders in advanced cancer. Journal of Palliative Care, 11(1), 10-18.
    McCorkle, R., Cooley, M., & Shea, J. (2000). A user's manual for the Symptom Distress Scale. New Haven, CT: Yale University.
    McCorkle, R., Jepson, C., Malone, D., Lusk, E., Braitman, L., Buhler-Wilkerson, K., et al. (1994). The impact of posthospital home care on patients with cancer. Research in Nursing and Health, 17(4), 243-251.
    McCorkle, R., Strumpf, N. E., Nuamah, I. F., Adler, D. C., Cooley, M. E., Jepson, C., et al. (2000). A specialized home care intervention improves survival among older post-surgical cancer patients. Journal of the American Geriatrics Society, 48(12), 1707-1713.
    McCorkle, R., & Young, K. (1978). Development of a symptom distress scale. Cancer Nursing, 1(5), 373-378.
    McWilliam, C. L., & Sangster, J. F. (1994). Managing patient discharge to home: The challenges of achieving quality of care. International Journal for Quality in Health Care, 6(2), 147-161.
    Morasso, G., Capelli, M., Viterbori, P., DiLeo, S., Alberisio, A., Constantini, M., et al. (1999). Psychological and symptom distress in terminal cancer patients with met and unmet needs. Journal of Pain and Symptom Management, 17(6), 402-409.
    Murtaugh, C. M., McCall, N., Moore, S., & Meadow, A. (2003). Trends in Medicare home health care use: 1997-2001. Health Affairs, 22(5), 146-156.
    National Cancer Institute. (2005). Cancer trends progress report—2005 update. Bethesda, MD: National Institutes of Health, Department of Health and Human Services.
    National Center for Health Statistics. (2001). Hospital stays grow shorter. Heart disease leading cause of hospitalization. Retrieved September 28, 2007, from
    Naylor, M. D., Brooten, D. A., Campbell, R. L., Jacobson, B. S., Mezey, M. D., Pauly, M. V., et al. (1999). Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA, 281(7), 613-620.
    Naylor, M. D., Brooten, D. A., Campbell, R. L., Maislin, G., McCauley, K. M., & Schwartz, J. S. (2004). Transitional care of older adults hospitalized with heart failure: A randomized, controlled trial. Journal of the American Geriatrics Society, 52(5), 675-684.
    Naylor, M. D., Brooten, D. A., Jones, R., Lavizzo-Mourey, R., Mezey, M. D., & Pauly, M. V. (1994). Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial. Annals of Internal Medicine, 120(12), 999-1006.
    Naylor, M. D., Stephens, C., Bowles, K. H., & Bixby, M. B. (2005). Cognitively impaired older adults: From hospital to home. American Journal of Nursing, 105(2), 52-61.
    Potthoff, S. J., Kane, R. L., & Franco, S. J. (1997). Improving hospital discharge planning for elderly patients. Health Care Financing Review, 19(2), 47-72.
    Prescott, P. A., Soeken, K. L., & Griggs, M. (1995). Identification and referral of hospitalized patients in need of home care. Research in Nursing and Health, 18(12), 85-95.
    Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychiatric Measure, 1(3), 385-401.
    Reilly, P., Iezzoni, L. I., Phillips, R., Davis, R. B., Tuchin, L., & Calkins, D. (1996). Discharge planning: Comparison of patients' and nurses' perceptions of patients following discharge planning. Image, 28(2), 143-147.
    Sarna, L., & Brecht, M. L. (1997). Dimensions of symptom distress in women with lung cancer: A factor analysis. Heart and Lung: Journal of Acute and Critical Care, 26(1), 23-30.
    Sellick, S. M., & Edwardson, A. D. (2007). Screening new cancer patients for psychological distress using the hospital anxiety and depression scale. Psycho-Oncology, 16(6), 534-542.
    Shepperd, S., Parkes, J., McClaran, J., & Phillips, C. (2004). Discharge planning from hospital to home. Cochrane Database of Systematic Reviews, 4, CD000313.
    Shyu, Y. I., & Lee, H. C. (2002). Predictors of nursing home placement and home nursing services utilization by elderly patients after hospital discharge in Taiwan. Journal of Advanced Nursing, 38(4), 398-406.
    Solomon, D. H., Wagner, D. R., Marenberg, M. E., Acampora, D., Cooney, L. M., & Inouye, S. K. (1993). Predictors of formal home health care use in elderly patients after hospitalization. Journal of the American Geriatrics Society, 41(9), 961-966.
    Yost, L. S. (1995). Cancer patients and home care: Extent to which required services are not received. Cancer Practice, 3(2), 83-87.
    Yost, L. S., McCorkle, R., Buhler-Wilkerson, K., Schultz, D., & Lusk, E. (1993). Determinants of subsequent home health care nursing service use by hospitalized patients with cancer. Cancer, 72(11), 3304-3312.