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 time to initiate and carry out 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 The 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.

Dying From COVID-19: Loneliness, End-of-Life Discussions, and Support for Patients and Their Families in Nursing Homes and Hospitals. A National Register Study

“…Moreover, ACP is also associated with fewer emergency department visits and fewer hospital deaths. 13 …”

“…Moreover, ACP is also associated with fewer emergency department visits and fewer hospital deaths. 13 To initiate EOL discussions is emotionally demanding. However, communication training might improve the outcome substantially, both with regard to the number of goals-of-care discussions and an increase in patient-rated quality of communication.…”

“…11 In a Swedish context however, EOL discussions generally occur late, sometimes just days before death, 12 which is in contrast to international findings regarding EOL discussions and/or ACP. 13 Still, they are considered valuable, and the National Board of Health and Welfare has listed EOL discussions as one of six quality indicators of palliative care. 14 For these reasons, variables such as dying with someone present (including family, friends, staff, hospital chaplains etc.)…”