Association Between Referral-to-Death Interval and Location of Death of Patients Referred to a Hospital-Based Specialist Palliative Care Service

Abstract

Longer referral-to-death interval was associated with death outside the hospital for patients enrolled in a hospital-based service. The study highlights the importance of early referral in predicting the last place of care and location of death of palliative care patients.

Length of home hospice care, family-perceived timing of referrals, perceived quality of care, and quality of death and dying in terminally ill cancer patients who died at home

“…The median length of referral from hospital to death at home was 35 days, and approximately 10 % of the patients died within 1 week. These findings are generally consistent with the existing literature, reporting that patients were referred to home hospice care at a late stage of cancer [4][5][6][7][8][9][10][11]. The fact that over 40 % of family members responded that the timing of referrals was late or too late suggests that the timing of referrals to home hospice care is likely to be delayed, and a strategy needs to be developed to improve this situation.…”

“…Multiple surveys from several countries, however, have consistently shown that physicians referred patients to hospice care services at the very latest stage of cancer: the median interval from referral to patient death ranged from 2 to 6 weeks and about 15 to 35 % of the patients died within a week after referral [4][5][6][7][8][9][10][11]. Some studies demonstrated that a shorter length of hospice enrollment was associated with an increased risk of major depressive disorder in family caregivers, less satisfaction with hospice care of family caregivers, and inadequate symptom management [9,[12][13][14][15][16].…”

“…On the other hand, some studies identified that the familyperceived timing of referrals, not the length of receiving hospice care itself, was significantly correlated with the family-perceived quality of care [4,6]. Many studies stressed the importance of appropriate referral to a hospice and/or palliative care service to identify unmet needs early, alleviate pain and suffering appropriately, and strengthen emotional connections between patients and their families [18][19][20][21].…”

What determines duration of palliative care before death for patients with advanced disease? A retrospective cohort study of community and hospital palliative care provision in a large UK city

“…It is however possible to broadly categorise the literature into those studies reporting exposure to hospital-based palliative care services and those reporting community or hospice-based services. Studies from the UK,16 17 the USA,18 19 Korea20 and Singapore21 report the median duration of HPC to range from 14.4 to 57 days and studies reporting CPC from Canada,22 Italy15 and Ireland7 report duration to range from 40 to 70 days. These studies provide useful context to the data reported here (20 days to HPC; 46 days CPC) and show the timing of referral to be consistent with that reported in the international literature.…”

The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study

“…We chose to divide patients according to the timing of PC decisions and service usage by using time periods before death on clinical grounds and thus complying with most of the previous studies; however, the lack of strict recommendations on this timing makes comparison between previous studies and the present study somewhat difficult. Regarding the timing of the PC initiation, in two previous studies [15,17] early PC referral was defined as a referral to PC >30 days, whereas in the study by Alsirafy and co-workers [16] the timing of PC referrals were categorized as early (> 90 days before death), intermediate (30-90 days before death) and late (<30 days before death). In the study by Nieder and co-workers [18], three months before death was chosen as a time point to distinguish between an early and late PC.…”