The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study

Abstract

Background: In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death. Methods: A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013-Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death. Results: A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (> 180 days prior to death 72% and < 14 days 10%). The number of ED visits and inpatient days were highest for patients with no PC decision and lowest for patients with both a PC decision and an PC unit appointment (60 days before death ED visits 1.3 vs 0.8 and inpatient days 9.9 vs 2.9 respectively, p < 0.01). Patients with no PC decision died more often in secondary/tertiary hospitals (28% vs. 19% with a PC decision, and 6% with a decision and an appointment to a PC unit). Conclusions: The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.

Reducing Futile Acute Care Services for Terminally Ill Patients With Cancer: The Dignity Project

“…A Finnish study looked at the duration between the decision for treatment with a palliative intent and the patient subsequently dying, which they found to be, on average, 46 days; most patients had a GOC with an appropriate code status assigned, but these decisions were found to have been taken closer to the point of the patient dying than they had aimed for. 18 Although not statistically significant, there was an increase in the number of patients identified as having a palliative intent for treatment post-MED-REM intervention; following through with the appropriate referrals for patients with this intent established is important to ensure that good palliation is achieved prior to the terminal phase of the disease and not just as a consequence of a deterioration in condition.…”

Effect of Palliative Care Decision on Use of Hospital Services in Pancreatic Cancer Patients: A Retrospective Study

“…The number of patients fulfilling the criteria was 221. This study is continuum to a recently published Finnish study (17). However, in the previous study, the larger cancer entities dominated and only a part of the pancreatic cancer patients were included.…”

“…In a recent Finnish study, late or lacking PC decision-making was found to be associated with more aggressive care close to death (16). PC intervention and an early PC decision have been shown to be associated with a drop in hospitalizations and visits to the emergency department (ED) during the last month of life, also creating cost benefits (17,18). Starting a new anticancer treatment or continuing ongoing treatment very close to death, repeated ED visits, inpatient hospital admissions, or intensive care unit stays near the EOL have been considered indicators of a poor quality of life (19).…”

Early palliative care in newly diagnosed cancer in Ethiopia: feasibility randomised controlled trial and cost analysis

“…3 The benefits of early PC are numerous and well studied in high-income settings, including improved quality of life and increased value in healthcare spending. [4][5][6] However, these outcomes are missing from low-and-middleincome countries (LMIC) and with it, the momentum to increase publicly available PC. [7][8][9] We therefore designed a pilot, feasibility randomised controlled trial (RCT) of early PC in newly diagnosed cancer patients in Addis Ababa, Ethiopia.…”

“…Palliative care (PC) aims to reduce pain and suffering for those with incurable disease 3. The benefits of early PC are numerous and well studied in high-income settings, including improved quality of life and increased value in healthcare spending 4–6. However, these outcomes are missing from low-and-middle-income countries (LMIC) and with it, the momentum to increase publicly available PC 7–9.…”