Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study

Abstract

Compared to the general population, people with pre-existing serious and persistent mental illness (SPMI) have higher rates of physical illness and die at an earlier age, raising questions about their palliative and end-of-life care needs when they are diagnosed with an incurable physical illness. In the present study, we explored access to specialist palliative care services within one New Zealand health district. Routinely-collected, de-identified patient information on a cohort of people diagnosed with SPMI, and receiving specialist palliative care services from the Capital and Coast District Health Board (CCDHB), was compared to the general population from the same health district. People with SPMI are 3.5 times less likely to receive specialist palliative services compared to the general population from the Capital and Coast District Health Board. The proportion of people identifying as Māori is 1.2 times higher in the SPMI cohort than the general CCDHB population. The SPMI cohort experiences a higher level of deprivation compared to the general population in the CCDHB. The present study confirms that those diagnosed with an SPMI are less likely to use specialist palliative care services at the end of life. Research using a national dataset is needed to determine whether the study findings are applicable to the national population.

End-of-life care and place of death in adults with serious mental illness: A systematic review and narrative synthesis

“…Health care use in the last year of life (23,24,(33)(34)(35)(36)(25)(26)(27)(28)(29)(30)(31)(32) Hospital (including ICU) (24,(26)(27)(28)(29)(30)(31)(32)35,36) • Rates of hospital admission in the last year of life ranged from 18.7% to 72.6% • Two studies (24,30) reported that people with SMI were more likely to be admitted in the last year of life whilst six studies (27,29,31,32,35,36) reported lower hospital care, although there was great heterogeneity amongst these studies • Mixed evidence was found describing ICU care and other interventions at end of life Emergency department (24,27,28,35) • ED attendance varied according to cause of death and urgency of visit • One study (35) reported more ED attendance in people with SMI and two studies (24,27) reported no difference Palliative care (23,(25)(26)(27)…”

“…Six studies reported receipt of palliative care (23,(25)(26)(27)29,34), notably four of these were among the most recent studies found in this systematic review of the evidence. Results regarding palliative care were particularly mixed.…”

“…Characteristics of the 23 included studies are presented in Table 1. Fourteen studies reported health care at end of life (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) and 13 studies reported place of death in patients with a serious mental illness (13,28,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) and. Four studies reported both outcomes (28,(34)(35)(36).…”

“…There was great variability in the size of the study sample from which the sample of people with serious mental illness. In two studies (28,32), the whole sample comprised eligible adult subjects with serious mental illness, whom were included in the synthesis of results, whilst other studies presented results for subsamples with serious mental illness from a Most studies were from the USA (13,24,(30)(31)(32)34,35,38) and Canada (29,36,43); the remaining studies were from Denmark (41,42), the UK (28,44), France (39), the Netherlands (25), Australia (27,33), New Zealand (23), Japan (40) and Taiwan (26,37). The mean/median age of subjects ranged between 47 and 79.…”

End-of-Life Care in Individuals With Serious Mental Illness

“…Population-level data from other health systems including Australia and New Zealand support Chochinov's finding that individuals with SMI are 2-4 times less likely than individuals without SMI to access palliative care services in the last months of life. 14,15 Data from studies in Taiwan and France are somewhat more ambiguous: depending on the metrics used and the subgroups studied, palliative care utilization by medically ill patients with SMI could be seen to be either increased or decreased, or both. 16,17 Data from the United States are limited.…”