Access to palliative care services in hospital: a matter of being in the right hospital. Hospital charts study in a Canadian city

Abstract

Access to palliative care (PC) is a major need worldwide. Using hospital charts of all patients who died over one year (April 2008-March 2009) in two mid-sized hospitals of a large Canadian city, similar in size and function and operated by the same administrative group, this study examined which patients who could benefit from PC services actually received these services and which ones did not, and compared their care characteristics. A significantly lower proportion (29%) of patients dying in hospital 2 (without a PC unit and reliant on a visiting PC team) was referred to PC services as compared to in hospital 1 (with a PC unit; 68%). This lower referral likelihood was found for all patient groups, even among cancer patients, and remained after controlling for patient mix. Referral was strongly associated with having cancer and younger age. Referral to PC thus seems to depend, at least in part, on the coincidence of being admitted to the right hospital. This finding suggests that establishing PC units or a team of committed PC providers in every hospital could increase referral rates and equity of access to PC services. The relatively lower access for older and non-cancer patients and technology use in hospital PC services require further attention.

Variation in out‐of‐hospital death among palliative care inpatients across public hospitals in New South Wales, Australia

“…Such in‐hospital characteristics may correspond to variation in palliative care resources and staffing, models and practices, including identification of patient, referral to palliative care, palliative care use and duration of care, transition to non‐acute setting, and out‐of‐hospital support. A well‐established palliative care unit in hospital increased palliative care use and was found to be more cost‐effective compared to hospitals with limited palliative care resources . The involvement of in‐hospital palliative care specialist team in a patient’s care, compared to the care with palliative intention and provided by other teams, can lead to better access to community or home‐based palliative care services at discharge and more out‐of‐hospital death.…”

Barriers to accessing palliative care: A review of the literature

“…(39) Even within systems, local differences can affect PC access. (40)(41)(42) Social and cultural factors play major roles in access to PC services. Rurality and physician availability is related to services provision, for example.…”

What Proportion of Terminally Ill and Dying People Require Specialist Palliative Care Services?

“…Following this, Canadian hospitals adopted palliative care principles to facilitate the open recognition of impending death and the provision of compassionate, holistic, and patient-centered end-of-life care [11,17]. Today, most but not all larger hospitals in Canada have palliative care units and/or specialist teams [19], most communities have palliative homecare services, some free-standing hospices have come to exist, and a small proportion of nursing homes have dedicated palliative care beds [20,21]. However, specialist palliative care services remain uncommon and entirely lacking in some areas [7,21,22], notably small Canadian cities, towns or villages, and rural areas [22,23].…”

“…With cardiovascular illnesses, care needs arising from peripheral edema and/or pulmonary edema are common [60]. All symptoms are very important to address, in part because severe and difficult-to-manage symptoms often result in hospitalizations International Journal of Palliative Care [19,26]. It is also important to note that physical care needs result from diagnostic tests and treatments.…”