Place of care: from referral to specialist palliative care until death

O'Leary, Mary Jane; O'Brien, Alison C; Murphy, Marie; Crowley, Claire M; Leahy, Helen; Mccarthy, Jill; COLLINS, J; O’Brien, Tony

doi:10.1136/bmjspcare-2014-000696

Cited by 9 publications

(10 citation statements)

References 29 publications

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“…Palliative care in the home interventions were evaluated with the primary outcomes of resource use, cost, or place of death in nearly one third of included studies. Some have argued that these outcomes are not sufficient to assess the effectiveness of the intervention [ 54 , 55 ]. The effectiveness measure should link to the objective of the intervention; place of death may be a less appropriate outcome than the location of care preceding death [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some have argued that these outcomes are not sufficient to assess the effectiveness of the intervention [ 54 , 55 ]. The effectiveness measure should link to the objective of the intervention; place of death may be a less appropriate outcome than the location of care preceding death [ 55 ]. Our findings underscore the need to expand outcome measurement beyond routinely collected data to measure outcomes that are more tightly linked to the objective of palliative care in the home.…”

Section: Discussionmentioning

confidence: 99%

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Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis

et al. 2018

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BackgroundThe aim of palliative care is to improve the quality of life of patients and families through the prevention and relief of suffering. Frequently, patients may choose to receive palliative care in the home. The objective of this paper is to summarize the quality and primary outcomes measured within the palliative care in the home literature. This will synthesize the current state of the literature and inform future work.MethodsA scoping review was completed using PRISMA guidelines. PubMed, Embase, CINAHL, Web of Science, Cochrane Library, EconLit, PsycINFO, Centre for Reviews and Dissemination, Database of Abstracts of Reviews of Effects, and National Health Service Economic Evaluation Database were searched from inception to August 2016. Inclusion criteria included: 1) care was provided in the “home of the patient” as defined by the study, 2) outcomes were reported, and 3) reported original data. Thematic component analysis was completed to categorize interventions.ResultsFifty-three studies formed the final data set. The literature varied extensively. Five themes were identified: accessibility of healthcare, caregiver support, individualized patient centered care, multidisciplinary care provision, and quality improvement. Primary outcomes were resource use, symptom burden, quality of life, satisfaction, caregiver distress, place of death, cost analysis, or described experiences. The majority of studies were of moderate or unclear quality.ConclusionsThere is robust literature of varying quality, assessing different components of palliative care in the home interventions, and measuring different outcomes. To be meaningful to patients, these interventions need to be consistently evaluated with outcomes that matter to patients. Future research could focus on reaching a consensus for outcomes to evaluate palliative care in the home interventions.Electronic supplementary materialThe online version of this article (10.1186/s12904-018-0299-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis

et al. 2018

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“…In an economic evaluation of specialist palliative care services in three parts of Ireland which have heterogeneous structures and resources for these services, Brick et al found that an area with well-developed specialist palliative care services and, where its role is understood, is likely to have more referrals and that these will in general be earlier [ 40 ]. O’Leary et al, in a study of one specialist palliative care service in Ireland over a 6-month period found late referral to palliative care was associated with receiving specialist palliative care in one care setting only but receiving care across multiple settings supported people to stay at home for longer [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Indicators for early assessment of palliative care in lung cancer patients: a population study using linked health data

Kelly

O’Brien

Lucey³

et al. 2018

BMC Palliat Care

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BackgroundAnalysing linked, routinely collected data may be useful to identify characteristics of patients with suspected lung cancer who could benefit from early assessment for palliative care. The aim of this study was to compare characteristics of newly diagnosed lung cancer patients dying within 30 days of diagnosis (short term survivors) with those surviving more than 30 days. To identify indicators for early palliative care assessment we distinguished between characteristics available at diagnosis (age, gender, smoking status, marital status, comorbid disease, admission type, tumour stage and histology) from those available post diagnosis. A second aim was to examine the association between receiving any tumour-directed treatment, place of death and survival time.MethodsA retrospective observational population based study comparing lung cancer patients who died within 30 days of diagnosis (short term survivors) with those who survived longer using Chi-squared tests and logistic regression. Incident lung cancer (ICD-03:C34) patients diagnosed 2005–2012 inclusive who died before 01–01-2014 (n = 14,228) were identified from the National Cancer Registry of Ireland linked to death certificate data and acute hospital episode data.ResultsOne in five newly diagnosed lung cancer patients died within 30 days of diagnosis. After adjusting for stage and histology, death within 30 days was higher in patients who were aged 80 years or older (adjusted OR 2.46; 95%CI 2.05–3.96; p < 0.001), patients with emergency admissions at diagnosis (adjusted OR 2.96; 95%CI 2.61–3.37; p < 0.001) and patients with any comorbidities at diagnosis (adjusted OR 1.32 95%CI 1.15–1.52; p < 0.001). Overall, 75% of those who died within 30 days died in hospital compared to 43% of longer term survivors.ConclusionsWe have shown a high proportion of lung cancer patients who die within 30 days of diagnosis are older, have comorbidities and are admitted through the emergency department. These characteristics, available at diagnosis, may be useful prognostic factors to guide decisions on early assessment for palliative care for lung cancer patients. Patients who die shortly after diagnosis are more likely to die in hospital so reporting place of death by survival time may be useful to evaluate interventions to reduce deaths in acute hospitals.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Following a randomised phase III trial in patients with small cell lung cancer, which demonstrated the benefit of early palliative care involvement in terms of quality of life and survival in 2010,1 the American Society of Clinical Oncology issued guidance recommending that palliative care should be considered early in the course of illness for any patient with metastatic cancer or high symptom burden 7. Despite this growing evidence base, within routine clinical practice in the UK palliative care clinicians report that many referrals are made in the last weeks or days of life.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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ObjectiveFor patients with advanced cancer, several randomised controlled trials have shown that access to palliative care at least 6 months before death can improve symptoms, reduce unplanned hospital admissions, minimise aggressive cancer treatments and enable patients to make choices about their end-of-life care, including exercising the choice to die at home. This study determines in a UK population the duration of palliative care before death and explores influencing factors.DesignThis retrospective cohort study analysed referrals to three specialist palliative care services; a hospital-based inpatient palliative care team, and two community-based services (hospices). For each patient referred to any of the above services we identified the date of first referral to that team and calculated the median interval between first referral and death. We also calculated how referral time varied by age, sex, diagnosis and type of palliative care service.Participants4650 patients referred to specialist palliative care services in Leeds UK between April 2012 and March 2014.ResultsMedian age of the sample was 75 years. 3903 (84.0%) patients had a diagnosis of cancer. Age, diagnosis and place of referral were significant predictors of duration of palliative care before death. Age was independently associated (J=2 672 078, z=−392046.14, r=0.01) with duration of palliative care regardless of diagnosis. Patients over 75 years have 29 fewer days of palliative care than patients under 50. Patients with non-cancer diagnoses have 13 fewer days of palliative care than patients with cancer. Additionally, patients referred to hospital palliative care receive 24.5 fewer days palliative care than those referred to community palliative care services.ConclusionsThe current timing of referral to palliative care may limit the benefits to patients in terms of improvements in end-of-life care, particularly for older patients and patients with conditions other than cancer.

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Place of care: from referral to specialist palliative care until death

Cited by 9 publications

References 29 publications

Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis

Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis

Indicators for early assessment of palliative care in lung cancer patients: a population study using linked health data

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

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