Comparative health care use patterns of people with schizophrenia near the end of life: A population-based study in Manitoba, Canada

Chochinov, Harvey Max; Martens, Patricia J.; Prior, Heather J.; Kredentser, Maia S.

doi:10.1016/j.schres.2012.07.028

Cited by 63 publications

(136 citation statements)

References 32 publications

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“…; Chochinov et al . ). There is complexity in providing end‐of‐life care for people with SPMI, and management is often complicated by the multiple comorbidities that these patients are diagnosed with (Bassirpour et al .…”

Section: Introductionmentioning

confidence: 97%

Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study

Butler

O’Brien

2017

Int J Mental Health Nurs

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Compared to the general population, people with pre-existing serious and persistent mental illness (SPMI) have higher rates of physical illness and die at an earlier age, raising questions about their palliative and end-of-life care needs when they are diagnosed with an incurable physical illness. In the present study, we explored access to specialist palliative care services within one New Zealand health district. Routinely-collected, de-identified patient information on a cohort of people diagnosed with SPMI, and receiving specialist palliative care services from the Capital and Coast District Health Board (CCDHB), was compared to the general population from the same health district. People with SPMI are 3.5 times less likely to receive specialist palliative services compared to the general population from the Capital and Coast District Health Board. The proportion of people identifying as Māori is 1.2 times higher in the SPMI cohort than the general CCDHB population. The SPMI cohort experiences a higher level of deprivation compared to the general population in the CCDHB. The present study confirms that those diagnosed with an SPMI are less likely to use specialist palliative care services at the end of life. Research using a national dataset is needed to determine whether the study findings are applicable to the national population.

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Section: Introductionmentioning

confidence: 97%

Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study

Butler

O’Brien

2017

Int J Mental Health Nurs

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“…SPMI is associated with premature mortality across all age groups [1,2]. Despite common misassumptions that most individuals with SPMI die prematurely from violence and suicide, the majority of excess mortality is due to chronic diseases such as cancer, heart disease, chronic obstructive pulmonary disease, and dementia [3,4].…”

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confidence: 99%

“…In a large cohort study of patients in the last six months of life, patients with schizophrenia were found to access palliative care at rates approximately half that of controls without schizophrenia [2]. Such lack of access to palliative care directly affects the management of end-of-life symptoms: patients with schizophrenia in the same study received significantly less opioid analgesia than did the control group.…”

mentioning

confidence: 99%

“…Such lack of access to palliative care directly affects the management of end-of-life symptoms: patients with schizophrenia in the same study received significantly less opioid analgesia than did the control group. Additionally, patients with schizophrenia were approximately twice as likely to spend their final days in a nursing home, and, once admitted to a nursing home, spend an average of more than twice the number of days as other nursing home residents [2]. Finally, this cohort of patients not only experienced poor quality end-of-life care; their contact with their psychiatric providers also declined in the setting of terminal illness [2].…”

mentioning

confidence: 99%

“…Additionally, patients with schizophrenia were approximately twice as likely to spend their final days in a nursing home, and, once admitted to a nursing home, spend an average of more than twice the number of days as other nursing home residents [2]. Finally, this cohort of patients not only experienced poor quality end-of-life care; their contact with their psychiatric providers also declined in the setting of terminal illness [2]. Palliative care disparities among the severely mentally ill are not limited to direct end-of-life care; a study comparing mentally ill and non-mentally ill nursing home residents in the United States found that mental illness was associated with a 24% odds reduction of a resident having any form of medical advanced directive [9].…”

mentioning

confidence: 99%

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A staggered edge: End-of-life care in patients with severe mental illness

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Arbuckle

et al. 2017

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Cancer care for individuals with schizophrenia

Irwin

Henderson

Knight

et al. 2013

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Individuals with schizophrenia are a vulnerable population that has been relatively neglected in health disparities research. Despite having an equivalent risk of developing most cancers, patients with schizophrenia are more likely to die of cancer than the general population. Cancer care disparities are likely the result of patient-, provider-, and systems-level factors and influenced by the pervasive stigma of mental illness. Individuals with schizophrenia have higher rates of health behaviors linked with cancer mortality including cigarette smoking. They also have significant medical comorbidity, are less likely to have up-to-date cancer screening, and may present at more advanced stages of illness. Patients with schizophrenia may be less likely to receive chemotherapy or radiotherapy, have more postoperative complications, and have less access to palliative care. However, opportunities exist for the interdisciplinary team, including medical, surgical, and radiation oncologists; psychiatrists; and primary care physicians, to intervene throughout the continuum of cancer care to promote survival and quality of life. This review summarizes data on overall and cancer-specific mortality for individuals with schizophrenia and reviews specific disparities across the cancer care continuum of screening, diagnosis, treatment, and end-of-life care. Using a case, the authors illustrate clinical challenges for this population including communication, informed consent, and risk of suicide, and provide suggestions for care. Finally, recommendations for research to address the disparities in cancer care for individuals with schizophrenia are discussed. Despite significant challenges, with collaboration between oncology and mental health teams, individuals with schizophrenia can receive high-quality cancer care. Cancer 2014;120:323-34.

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Comparative health care use patterns of people with schizophrenia near the end of life: A population-based study in Manitoba, Canada

Cited by 63 publications

References 32 publications

Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study

Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study

A staggered edge: End-of-life care in patients with severe mental illness

Cancer care for individuals with schizophrenia

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