Factors Associated with End-of-Life Health Service Use in Patients Dying of Cancer

Abstract

This study describes acute care hospital death, physician house calls and home care near the end of life among patients who died of cancer and the factors that are associated with these events and services. It is a population-based retrospective study that uses linked administrative healthcare data. The cohort includes all patients who died of cancer between 2000 and 2004 in Ontario, Canada.Fifty-five per cent of patients died in acute care hospital, 68% received home care in the last 6 months of life and 24% received at least one physician house call in the last 2 weeks of life. Increased age was associated with a decreased likelihood of each event or service. women were less likely to die in acute care and more likely to receive home care. Residents in low-income neighbourhoods were less likely to receive house calls or home care. Patients who received home care or house calls were less likely to die in acute care.Our observations add to those in the literature, suggesting a need to increase the use of supportive care services at the end of life in hopes of decreasing the need for acute care. They also serve as a baseline for future comparison, which is of particular interest since new government policies directed at end-of-life care were recently introduced.

Quality of End-of-Life Cancer Care in Canada: A Retrospective Four-Province Study Using Administrative Health Care Data

“…The indicator values and associations reported here are in keeping with earlier Canadian results 24,33 . Notably, in all provinces studied, patients living in lower-income neighbourhoods were less likely to receive supportive care and, in Ontario, were more likely to receive aggressive care.…”

“…Its population-based cohorts of cancer decedents were identified using a common method, and it examines care provided in the inpatient, ambulatory, and community settings. Earlier work was conducted primarily within single provinces 14,[33][34][35][36][37][38][39] . The provincial populations included in the present study account for more than half the Canadian population.…”

“…Those criticisms have included lack of expertise and of adequate home support services, lack of coordinated comprehensive programs, fragmentation of care, and inadequate caregiver support. Although eol care has been studied in several provinces 14,22,[33][34][35][36][37][38][39] , the quality of data for comparing eol care in cancer patients across Canada is poor.…”

Access to Oncology Consultation in a Cancer Cohort in Northeastern Ontario

“…Similarly, our study also demonstrates that older cancer patients might have decreased access to cancer specialists 18,23 and cancer services 18,20,24,25 . Having a consultation was also significantly associated with a longer duration of disease.…”

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“…[33] Using vacuum extractors in midwifery, for example, requires special care. [34] Medical supplies such as drugs, equipment, and other consumables are an important part of all curative and preventive services. Essential medicines and medical supplies that form the approved treatment protocol for maternity care should be available at ll service points.…”