Intensity of integrated cancer palliative care plans and end-of-life acute medical hospitalisation among cancer patient in Northern Italy

Abstract

A high hospital utilisation at the end of life (EOL) is an indicator of suboptimal quality of health care. We evaluated the impact of the intensity of different Integrated Cancer Palliative Care (ICPC) plans on EOL acute medical hospitalisation among cancer decedents. Decedents of cancer aged 18–84 years, who were residents in two Italian regions, were investigated through integrated administrative data. Outcomes considered were prolonged hospital stay for medical reasons, 2+ hospitalisations during the last month of life and hospital death. The ICPC plans instituted 90 to 31 days before death represented the main exposure of interest. Other variables considered were gender, age class at death, marital status, recent hospitalisation and primary cancer site. Among 6,698 patients included in ICPC plans, 44.3% presented at least one critical outcome indicator; among these, 76.5% died in hospital, 60.3% had a prolonged (12+ days) medical hospitalisation, 19.1% had 2+ hospitalisations at the EOL. These outcomes showed a strong dose–response effect with the intensity of the ICPC plans, which is already evident at levels of moderate intensity. A well‐ICPC approach can be very effective—beginning at low levels of intensity of care—in reducing the percentage of patients spending many days or dying in hospital.

Use of healthcare services at the end of life in decedents compared to their surviving counterparts: A case-control study among adults born before 1946 in Friuli Venezia Giulia

“…In Italy, a study conducted in the Regions of Emilia Romagna and Veneto seems to suggest that well-integrated palliative care approach can be effective in further reducing the percentage of patients who spend many days in hospital and/or undergo frequent and inappropriate changes of their care setting during the last month of life [40]. Those results were confirmed by other studies in patients with cancer, conducted in the same geographical areas [25,41]. These results underline how enhancing palliative care and reducing hospitalization during the EOL period were associated with an increase in patient and family satisfaction [41].…”

“…Furthermore, most studies on healthcare at the EOL, focused on its costs [21–24] and only a limited number considered utilization itself [9,19]. Some studies are concentrated exclusively on decedents that died of specific diseases, such as cancer [25–27] or patients affected by COPD and lung cancer [23], or Alzheimer’s disease [28] and many other conditions.…”

Inequity in palliative care service full utilisation among patients with advanced cancer: a retrospective Cohort study

“…Conversely, women are more likely to be widowed or living alone, with a higher need for institutionalisation [53]. Younger patients were served late by specialised palliative care services, and this may correlate with their higher probability of experiencing aggressive hospital treatment, which can delay referral to specialised palliative care services [54].…”

Evaluación de la atención sanitaria en el proceso de muerte de pacientes con patologías respiratorias

“…Tras siete años de la aprobación de la primera ley autonómica española que regula el proceso de muerte, este estudio muestra intervenciones aceptables en el episodio del fallecimiento pero también evidencia áreas de mejoras en la atención al final de la vida, fundamentalmente en lo relativo a la información, la toma de decisiones compartidas y aspectos sobre el seguimiento domiciliario y cuidados paliativos. Existen autores que apuestan por los Planes Integrales de Cuidados Paliativos como herramienta para alcanzar niveles óptimos de calidad asistencial y reducir el porcentaje de pacientes que mueren en los hospitales 6 , y otros que tras sus estudios concluyen que son necesarias estrategias de transición del lugar de la muerte al hogar, además de reconocer la necesidad de mejorar la calidad de la atención hospitalaria como objetivo prioritario de los cuidados 7 .…”