A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on?

Abstract

BackgroundHistorically, specialist palliative care has been accessed by a greater proportion of people dying with cancer compared to people with other life-limiting conditions. More recently, a variety of measures to improve access to palliative care for people dying from non-cancer conditions have been implemented. There are few rigorous population-based studies that document changes in palliative care service delivery relative to the number of patients who could benefit from such services.MethodA retrospective cohort study of the last year of life of persons with an underlying cause of death in 2009–10 from cancer, heart failure, renal failure, liver failure, chronic obstructive pulmonary disease, Alzheimer’s disease, motor neurone disease, Parkinson’s disease, Huntington’s disease and/or HIV/AIDS. The proportion of decedents receiving specialist palliative care was compared to a 2000–02 cohort. Logistic regression models were used identify social and demographic factors associated with accessing specialist palliative care.ResultsThere were 12,817 deaths included into the cohort; 7166 (56 %) from cancer, 527 (4 %) from both cancer and non-cancer conditions and 5124 (40 %) from non-cancer conditions. Overall, 46.3 % of decedents received community and/or hospital based specialist palliative care; a 3.5 % (95 % CI 2.3–4.7) increase on specialist palliative care access reported ten years earlier. The majority (69 %; n = 4928) of decedents with cancer accessed palliative care during the last year of life. Only 14 % (n = 729) of decedents with non-cancer conditions accessed specialist palliative care, however, this represented a 6.1 % (95 % CI 4.9–7.3) increase on the specialist palliative care access reported for the same decedent group ten years earlier. Compared to decedents with heart failure, increased odds of palliative care access was observed for decedents with cancer (OR 10.5; 95 % CI 9.1–12.2), renal failure (OR 1.5; 95 % CI 1.3–1.9), liver failure (OR 2.3; 95 % CI 1.7–3.3) or motor neurone disease (OR 4.5; 95 % CI 3.1–6.6). Living in major cities, being female, having a partner and living in a private residence was associated with increased odds of access to specialist palliative care.ConclusionThere is small but significant increase in access to specialist palliative care services in Western Australia, specifically in patients dying with non-cancer conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0119-2) contains supplementary material, which is available to authorized users.

Is admittance to specialised palliative care among cancer patients related to sex, age and cancer diagnosis? A nation-wide study from the Danish Palliative Care Database (DPD)

“…Our results are in line with earlier studies [21] although the age gradient was much stronger in our study [16, 22–25]. Comparing the youngest with the oldest patients a stronger association was found for hospital-based palliative care team/unit (OR = 6.81; 5.53–8.38) than for hospice (OR = 3.17; 2.57–3.97).…”

Tracking patients with advanced kidney disease in the last 12 months of life

“…In a large retrospective Australian study of people who had accessed PCS (n ¼ 12,817), those with renal failure (8.9% of the sample; CKD stage and modality type were not reported) received a median of six days of PCS as compared with 30 days received by those with a cancer diagnosis (56% of the total sample) (Rosenwax et al 2016). With the slow progression of CKD accompanied by acute and unpredictable exacerbations of clinical problems (Ngu et al 2017), concomitant comorbid conditions and multiplicity of treatment pathways (conservative, renal replacement therapies), flexible and extended palliative care support may be required.…”

IDentification of patients in need of general and specialised PALLiative care (ID-PALL©): item generation, content and face validity of a new interprofessional screening instrument.

“…Following literature findings that people with life limiting non-cancer conditions have less access to palliative care (16,23), the items were designed for patients with either oncological or nononcological pathologies. Finally, the CICE determined which items belonged in the generalised PC or specialised PC categorisations.…”

“…Proportions of patients with PC needs varies (9%-73%), and people are often identified late, which bears important consequences for care (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). These consequences include, but are not limited to (i) excess hospital mortality, whereby 80% of palliative patients die in hospital when the majority of people wish to die at home (19,20); (ii) suboptimal symptom management (21)(22)(23); (iii) unplanned hospitalisations with long hospital stays (24,25); (iv) prescription of inappropriate treatments due to a lack of advance care planning (26,27); and, (v) insufficient support for the patient and their relatives (24,28,29).…”