Preferred Place of Care and Death in Terminally Ill Patients with Lung and Heart Disease Compared to Cancer Patients

Skorstengaard, Marianne Hjorth; Neergaard, Mette Asbjoern; Andreassen, Pernille; Brogaard, Trine; Bendstrup, Elisabeth; Løkke, Anders; Aagaard, Susanne; Wiggers, Henrik; Bech, Per; Jensen, Anders Bonde

doi:10.1089/jpm.2017.0082

Cited by 57 publications

(53 citation statements)

References 25 publications

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“…Dying in acute care hospitals is a widely recognized indicator of the low quality of EOL care as acute care hospitals are not generally designed to meet the needs of terminally ill patients in terms of symptom control and alleviation [ 35 , 37 , 38 ]. It may be argued that this difference in the place of death may reflect an underlying difference in EOL preferences by diagnosis; however, the literature reports that most CHF and COPD patients prefer to die at home or at non-acute-care care institutions and that these preferences seem to mirror those of patients suffering from malignant diseases [ 41 , 42 , 43 ]. Furthermore, non-malignant patients are reported to experience a higher risk of incongruence between the preferred and actual place of death than cancer patients [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis-related differences in the quality of end-of-life care: A comparison between cancer and non-cancer patients

et al. 2018

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BackgroundCancer, chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD) in the advanced stages have similar symptom burdens and survival rates. Despite these similarities, the majority of the attention directed to improving the quality of end-of-life (EOL) care has focused on cancer.AimTo assess the extent to which the quality of EOL care received by cancer, CHF, and COPD patients in the last month of life is diagnosis-sensitive.MethodsThis is a retrospective observational study based on administrative data. The study population includes all Tuscany region residents aged 18 years or older who died with a clinical history of cancer, CHF, or COPD. Decedents were categorized into two mutually exclusive diagnosis categories: cancer (CA) and cardiopulmonary failure (CPF). Several EOL care quality outcome measures were adopted. Multivariable generalized linear model for each outcome were performed.ResultsThe sample included 30,217 decedents. CPF patients were about 1.5 times more likely than cancer patients to die in an acute care hospital (RR 1.59, 95% C.I.: 1.54–1.63). CPF patients were more likely to be hospitalized or admitted to the emergency department (RR 1.09, 95% C.I.: 1.07–1.10; RR 1.15, 95% C.I.: 1.13–1.18, respectively) and less likely to use hospice services (RR 0.08, 95% C.I.: 0.07–0.09) than cancer patients in the last month of life. CPF patients had a four- and two-fold higher risk of intensive care unit admission or of undergoing life-sustaining treatments, respectively, than cancer patients (RR 3.71, 95% C.I.: 3.40–4.04; RR 2.43, 95% C.I.: 2.27–2.60, respectively).ConclusionThe study has highlighted the presence of significant differences in the quality of EOL care received in the last month of life by COPD and CHF compared with cancer patients. Further studies are needed to better elucidate the extent and the avoidability of these diagnosis-related differences in the quality of EOL care.

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Section: Discussionmentioning

confidence: 99%

Diagnosis-related differences in the quality of end-of-life care: A comparison between cancer and non-cancer patients

et al. 2018

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“…As we live longer with more comorbidities, the complexity of need at the end of life is bound to increase. This coupled with the projected rise in numbers of people dying with cancer over the next two decades and people's preference to be cared for and die at home or in a home-like environment [2][3][4], highlights the importance that providing quality care and support to people with terminal cancer in the community care settings. It is also a policy priority for health care in many countries [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…It is a holistic approach of care and deemed more appropriate for patients at the end of life. Primary care providers are particularly well positioned to deliver primary palliative care, due to the longitudinal nature of their relationships with patients and families, delivering care in people's most preferred care settings [2][3][4]. It is unclear if a patient's palliative care needs known to their GPs plays a role in the primary care service use of the patient.…”

Section: Introductionmentioning

confidence: 99%

Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

et al. 2020

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Background: End of life (EoL) care becomes more complex and increasingly takes place in the community, but there is little data on the use of general practice (GP) services to guide care improvement. This study aims to determine the trends and factors associated with GP consultation, prescribing and referral to other care services amongst cancer patients in the last year of life. Methods: A retrospective cohort study of cancer patients who died in 2000-2014, based on routinely collected primary care data (the Clinical Practice Research DataLink, CPRD) covering a representative sample of the population in the United Kingdom. Outcome variables were number of GP consultations (primary), number of prescriptions and referral to other care services (yes vs no) in the last year of life. Explanatory variables included socio-demographics, clinical characteristics and the status of palliative care needs recognised or not. The association between outcome and explanatory variables were evaluated using multiple-adjusted risk ratio (aRR). Results: Of 68,523 terminal cancer patients, 70% were aged 70+, 75% had comorbidities and 45.5% had palliative care needs recognised. In the last year of life, a typical cancer patient had 43 GP consultations (Standard deviation (SD): 31.7; total = 3,031,734), 71.5 prescriptions (SD: 68.0; total = 5,074,178), and 21(SD: 13.0) different drugs; 58.0% of patients had at least one referral covering all main clinical specialities. More comorbid conditions, prostate cancer and having palliative care needs recognised were associated with more primary care consultations, more prescriptions and a higher chance of referral (aRRs 1.07-2.03). Increasing age was related to fewer consultations (aRRs 0.77-0.96), less prescriptions (aRR 1.09-1.44), and a higher chance of referral (aRRs 1.08-1.16) but less likely to have palliative care needs recognised (aRRs 0.53-0.89).

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“…; Skorstengaard et al . ). As a result, much of the development of EoL care and palliative care services has been focused on the goal of increasing the proportion of patients dying at home.…”

Section: Discussionmentioning

confidence: 97%

End‐of‐life care among older cancer patients with intellectual disability in comparison with the general population: a national register study

Segerlantz

Axmon

Ahlström

2020

J intellect Disabil Res

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Background Increasing life expectancy for people with an intellectual disability (ID) is resulting in more persons with cancer and a greater need for end-of-life (EoL) care. There is a need for knowledge of health care utilisation over the last year of life to plan for resources that support a high quality of care for cancer patients with ID. Therefore, the aims of the study were to compare (1) health care utilisation during the last year of life among cancer patients with ID and cancer patients without ID and (2) the place of death in these two groups. Methods The populations were defined using national data from the period 2002-2015, one with ID (n = 15 319) and one matched 5:1 from the general population (n = 72 511). Cancer was identified in the Cause of Death Register, resulting in two study cohorts with 775 cancer patients with ID (ID cohort) and 2968 cancer patients from the general population (gPop cohort).

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Preferred Place of Care and Death in Terminally Ill Patients with Lung and Heart Disease Compared to Cancer Patients

Abstract: Patient preferences for PPOC and PPOD vary according to their diagnoses; tailoring palliative needs to patients' preferences is important regardless of their diagnosis.

Cited by 57 publications

References 25 publications

Diagnosis-related differences in the quality of end-of-life care: A comparison between cancer and non-cancer patients

Diagnosis-related differences in the quality of end-of-life care: A comparison between cancer and non-cancer patients

Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

End‐of‐life care among older cancer patients with intellectual disability in comparison with the general population: a national register study

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