Variation in geographic access to specialist inpatient hospices in England and Wales

Gatrell, Anthony C.; Wood, Dora

doi:10.1016/j.healthplace.2012.03.009

Cited by 31 publications

(37 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[23] The wide geographic variations in place of death are likely to represent service availability and accessibility. A study by Gatrell et al [24] looked at variations in geographic access to hospices in England and Wales and showed that there are inequities in provision of beds between regions, with the lowest numbers of beds per 1000 cancer deaths in the North East and East Midlands; which corresponds to the two cancer Networks with the lowest proportion of patients dying within hospice beds in our study (North of England and East Midlands). Furthermore a piece of work from Sleeman et al [25] suggested that those from a more affluent background were more likely to die in a hospice setting than those from the most deprived socio-economic grouping, suggesting that inequities in access are not only geographic.…”

Section: Discussionmentioning

confidence: 58%

Place of Death in Patients with Lung Cancer: A Retrospective Cohort Study from 2004-2013

et al. 2016

View full text Add to dashboard Cite

IntroductionMany patients with cancer die in an acute hospital bed, which has been frequently identified as the least preferred location, with psychological and financial implications. This study looks at place and cause of death in patients with lung cancer and identifies which factors are associated with dying in an acute hospital bed versus at home.Methods and FindingsWe used the National Lung Cancer Audit linked to Hospital Episode Statistics and Office for National Statistics data to determine cause and place of death in those with lung cancer; both overall and by cancer Network. We used multivariate logistic regression to compare features of those who died in an acute hospital versus those who died at home.ResultsOf 143627 patients identified 40% (57678) died in an acute hospital, 29% (41957) died at home and 17% (24108) died in a hospice. Individual factors associated with death in an acute hospital bed compared to home were male sex, increasing age, poor performance status, social deprivation and diagnosis via an emergency route. There was marked variation between cancer Networks in place of death. The proportion of patients dying in an acute hospital ranged from 28% to 48%, with variation most notable in provision of hospice care (9% versus 33%). Cause of death in the majority was lung cancer (86%), with other malignancies, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) comprising 9% collectively.ConclusionsA substantial proportion of patients with lung cancer die in acute hospital beds and this is more likely with increasing age, male sex, social deprivation and in those with poor performance status. There is marked variation between Networks, suggesting a need to improve end-of-life planning in those at greatest risk, and to review the allocation of resources to provide more hospice beds, enhanced community support and ensure equal access.

show abstract

Section: Discussionmentioning

confidence: 58%

Place of Death in Patients with Lung Cancer: A Retrospective Cohort Study from 2004-2013

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The location of children's hospices with the majority being in less deprived areas and only two in multicultural areas may be of concern. Previous research assessing access to adult hospices in England and Wales used more sophisticated access measures and found that rural and relatively deprived areas had poorer access than urban areas (Gatrell, 2012).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of life-limiting conditions in children and young people in England: Time trends by area type

Norman

Fraser

2014

Health & Place

View full text Add to dashboard Cite

Palliative care services in England lack of data on the number of children with 'life limiting conditions' (LLCs). Recent research determined that the prevalence of LLCs in children in England was double previous estimates. We analyse time-trends in the prevalence of LLCs by deprivation and geodemographic area types.Prevalence is highest for children aged less than one year but time trends show no increase for the youngest age group but significant increases for older children. These increases are mirrored by a decrease in all cause mortality for children aged less than one year suggesting improved survival. Whilst the majority of children with LLC live within 20km of a children's hospice this service may still not be accessible due to lack of transport or other factors. Increasing prevalence may require increased paediatric palliative care service provision in the future.

show abstract

“…With the rapid development of GIS techniques, it also becomes convenient to compute the network-based distance based on a GIS road network layer. This results in the frequently used measure of the shortest travel time (or nearest travel distance) to the service locations for assessing service accessibility [6], [7], [10], [11], [12], [14], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67]. Recently, it has become feasible to create a composite accessibility index using a state-of-the-art two-Step Floating Catchment Area (2SFCA) approach.…”

Section: Discussionmentioning

confidence: 99%

Comparing GIS-Based Measures in Access to Mammography and Their Validity in Predicting Neighborhood Risk of Late-Stage Breast Cancer

2012

View full text Add to dashboard Cite

BackgroundAssessing neighborhood environment in access to mammography remains a challenge when investigating its contextual effect on breast cancer-related outcomes. Studies using different Geographic Information Systems (GIS)-based measures reported inconsistent findings.MethodsWe compared GIS-based measures (travel time, service density, and a two-Step Floating Catchment Area method [2SFCA]) of access to FDA-accredited mammography facilities in terms of their Spearman correlation, agreement (Kappa) and spatial patterns. As an indicator of predictive validity, we examined their association with the odds of late-stage breast cancer using cancer registry data.ResultsThe accessibility measures indicated considerable variation in correlation, Kappa and spatial pattern. Measures using shortest travel time (or average) and service density showed low correlations, no agreement, and different spatial patterns. Both types of measures showed low correlations and little agreement with the 2SFCA measures. Of all measures, only the two measures using 6-timezone-weighted 2SFCA method were associated with increased odds of late-stage breast cancer (quick-distance-decay: odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.01–1.32; slow-distance-decay: OR = 1.19, 95% CI = 1.03–1.37) after controlling for demographics and neighborhood socioeconomic deprivation.ConclusionsVarious GIS-based measures of access to mammography facilities exist and are not identical in principle and their association with late-stage breast cancer risk. Only the two measures using the 2SFCA method with 6-timezone weighting were associated with increased odds of late-stage breast cancer. These measures incorporate both travel barriers and service competition. Studies may observe different results depending on the measure of accessibility used.

show abstract

Variation in geographic access to specialist inpatient hospices in England and Wales

Cited by 31 publications

References 20 publications

Place of Death in Patients with Lung Cancer: A Retrospective Cohort Study from 2004-2013

Place of Death in Patients with Lung Cancer: A Retrospective Cohort Study from 2004-2013

Prevalence of life-limiting conditions in children and young people in England: Time trends by area type

Comparing GIS-Based Measures in Access to Mammography and Their Validity in Predicting Neighborhood Risk of Late-Stage Breast Cancer

Contact Info

Product

Resources

About