Impact of comprehensive hospice palliative care on end-of-life care: a propensity-score–matched retrospective observational study

Abstract

F or patients with cancer facing terminal illness, a hospice palliative care approach is an important component of quality care and can offer many benefits to patients and their families, including pain and symptom management, coordination of care and improved quality of life. 1-4 In addition, a hospice palliative care approach offers substantial benefits to the health care system, including the decreased use of potentially aggressive end-of-life care, 4 which is costly 5-7 and is often not the wish of patients. 8 The Symptom Management Program at the Northeast Cancer Centre of Health Sciences North, Sudbury, Ontario, was established in 2011. It is an ambulatory program that uses a hospice palliative care approach for patients with cancer who have terminal disease. Although not restrictive, the primary catchment area of the program includes residents within the Greater Sudbury and District region. The primary purpose of this study was to determine the association between delivery of comprehensive hospice palliative care through the Symptom Management Program and the use of potentially aggressive care in the last month of life as well as place of death, compared to a matched cohort of deceased patients with cancer who had received palliative care and were not participants of the program. A secondary objective was to assess family caregiver satisfaction with the advanced cancer care delivered through the Symptom Management Program.

Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups

“…Comparison with other studies Many studies have reported on the relationship between PC exposure and hospital-based acute care near the EOL in patients with cancer, [15][16][17][18][19][20][21] consistently finding that PC exposure reduces risk of hospital-based care near the EOL. Fewer studies have focused on patients without cancer, and results have been limited to the disease categories examined (heart failure, [36][37][38][39] dementia, 40 41 end-stage renal disease (ESRD), 42 43 and end-stage liver disease 44 ).…”

“…Many studies have reported on the relationship between PC exposure and healthcare resource use near the EOL for patients with cancer, [15][16][17][18][19][20][21] consistently finding that PC exposure reduces risk of hospital-based care near the EOL. Recently, the same was found to be true for patients with many of the most common chronic diseases; however, questions remain about the role of PC timing on these outcomes.…”

A retrospective cohort study evaluating correlates of deep tissue infections among patients enrolled in opioid agonist treatment using administrative data in Ontario, Canada

“…Income is classified into five categories: 1 (lowest), 2, 3, 4, 5 (highest). The income quintiles were chosen based on recent peer reviewed literature using ICES data [48][49][50], and the importance of placing this work in the context of other studies in the field. Income quintile was only considered at the index date, and we did not account for patients moving between neighborhoods.…”

Pursuing a Good Death in the Time of COVID-19

“…This is important, as this might be the only visual evidence of the patient's death and it is also cathartic for the NOK who were unable to visit or communicate with the patient prior to their passing. 4 Regarding funeral arrangements, a list of certified funeral companies who are able to comply with infection precautions should be provided. In Singapore, funerals are held with a windowless casket and are limited to a maximum of 3 days, with no more than 10 in attendance.…”