Comparison of Palliative Care Delivery in the Last Year of Life Between Adults With Terminal Noncancer Illness or Cancer

Quinn, Kieran L.; Wegier, Peter; Stukel, Thérèse A.; Huang, Anjie; Bell, Chaim M.; Tanuseputro, Peter

doi:10.1001/jamanetworkopen.2021.0677

Cited by 50 publications

(37 citation statements)

References 51 publications

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“…Patients with nonmalignant disease have a less predictable course due to the frequent variability in the progression of their disease [12] and the lack of awareness of palliative care among caregivers and health professionals [13]. Recent findings in the study by Quinn et al provide important data about the clinical benefits of palliative care in patients with noncancer diseases, showing that palliative care is associated with reduced acute care service use, mitigation of symptoms, and increased advance care planning in patients with non-cancer diseases [14].…”

Section: Introductionmentioning

confidence: 99%

The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives

Kasdorf

Dust

Hamacher

et al. 2022

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Purpose To compare health care experiences of patients with cancer or non-cancer diseases in their last year of life. Methods A cross-sectional post-bereavement survey was conducted using an adapted German version of the VOICES questionnaire (VOICES-LYOL-Cologne). Differences in the reported experiences were assessed using a two-sided Pearson’s chi-square test and Mann–Whitney U test. Results We collected data from 351 bereaved relatives. More than half of non-cancer patients were not informed that their disease could lead to death (p < 0.001). When this was communicated, in 46.7% of non-cancer and 64.5% of cancer patients, it was reported by the hospital doctor (p = 0.050). In all, 66.9% of non-cancer and 41.6% of cancer patients were not informed about death being imminent (p < 0.001). On average, non-cancer patients had significantly fewer transitions and hospital stays in their last year of life (p = 0.014; p = 0.008, respectively). Non-cancer patients were treated more often by general practitioners, and cancer patients were treated more often by specialists (p = 0.002; p = 0.002, respectively). A substantially lower proportion of non-cancer patients were treated by at least one member of or in the setting of general or specialized palliative care (p < 0.001). Conclusions Non-cancer patients experience disadvantages in communication regarding their care and in access to specialized palliative care in their last year of life compared to cancer patients. Regarding the assessment of palliative care needs and the lack of communication of an incurable disease, non-cancer patients are underserved. An early identification of patients requiring palliative care is a major public health concern and should be addressed irrespective of diagnosis. Trial registration Prospectively registered by the German Clinical Trials Register (DRKS00011925, data of registration: 13.06.2017).

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Section: Introductionmentioning

confidence: 99%

The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives

Kasdorf

Dust

Hamacher

et al. 2022

Support Care Cancer

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“…Multiple randomized controlled trials, and other clinical trials, have shown that a palliative approach to care is beneficial to improve the dying experience and patient outcomes including improved well-being, symptom management, quality-of-life, satisfaction with care and decreased caregiver distress and Emergency Department visits at the end of life [1][2][3][4][5][6][7][8]. Despite evidence of the benefits of palliative care in non-cancer populations, referrals to palliative care services are more often happening in cancer patients versus non-cancer patients [9][10][11][12][13][14]. One reason for this might be that unmet symptoms and their symptom trajectories are very well described in the cancer population, as compared to the non-cancer population (e.g., chronic lung disease, chronic heart disease, renal disease and Alzheimer's dementia) where the illness trajectory tends to be much less predictable [15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort

et al. 2021

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Introduction The end-of-life symptom prevalence of non-cancer patients have been described mostly in hospital and institutional settings. This study aims to describe the average symptom trajectories among non-cancer patients who are community-dwelling and used home care services at the end of life. Materials and methods This is a retrospective, population-based cohort study of non-cancer patients who used home care services in the last 6 months of life in Ontario, Canada, between 2007 and 2014. We linked the Resident Assessment Instrument for Home Care (RAI-HC) (standardized home care assessment tool) and the Discharge Abstract Databases (for hospital deaths). Patients were grouped into four non-cancer disease groups: cardiovascular, neurological, respiratory, and renal (not mutually exclusive). Our outcomes were the average prevalence of these outcomes, each week, across the last 6 months of life: uncontrolled moderate-severe pain as per the Pain Scale, presence of shortness of breath, mild-severe cognitive impairment as per the Cognitive Performance Scale, and presence of caregiver distress. We conducted a multivariate logistic regression to identify factors associated with having each outcome respectively, in the last 6 months. Results A total of 20,773 non-cancer patient were included in our study, which were analyzed by disease groups: cardiovascular (n = 12,923); neurological (n = 6,935); respiratory (n = 6,357); and renal (n = 3,062). Roughly 80% of patients were > 75 years and half were female. In the last 6 months of life, moderate to severe pain was frequent in the cardiovascular (57.2%), neurological (42.7%), renal (61.0%) and respiratory (58.3%) patients. Patients with renal disease had significantly higher odds for reporting uncontrolled moderate to severe pain (odds ratio [OR] = 1.21; 95% CI: 1.08 to 1.34) than those who did not. Patients with respiratory disease reported significantly higher odds for shortness of breath (5.37; 95% CI, 5.00 to 5.80) versus those who did not. Patients with neurological disease compared to those without were 9.65 times more likely to experience impaired cognitive performance and had 56% higher odds of caregiver distress (OR = 1.56; 95% CI: 1.43 to 1.71). Discussion In our cohort of non-cancer patients dying in the community, pain, shortness of breath, impaired cognitive function and caregiver distress are important symptoms to manage near the end of life even in non-institutional settings.

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“…Although not its intended purpose, palliative care may simultaneously reduce healthcare use and its associated costs in patients opting for less aggressive and generally more expensive care. 23–29 Yet one third of patients who die in hospital do not access palliative care. 30 One approach to improving value at the end-of-life may be to focus efforts on the specific subgroup of high cost patients at a unique juncture in time—to prevent potentially unwanted aggressive treatment, such as during the hospitalization in which they die.…”

Section: Introductionmentioning

confidence: 99%

Association between high cost user status and end-of-life care in hospitalized patients: A national cohort study of patients who die in hospital

et al. 2021

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Background: Studies comparing end-of-life care between patients who are high cost users of the healthcare system compared to those who are not are lacking. Aim: The objective of this study was to describe and measure the association between high cost user status and several health services outcomes for all adults in Canada who died in acute care, compared to non-high cost users and those without prior healthcare use. Settings and participants: We used administrative data for all adults who died in hospital in Canada between 2011 and 2015 to measure the odds of admission to the intensive care unit (ICU), receipt of invasive interventions, major surgery, and receipt of palliative care during the hospitalization in which the patient died. High cost users were defined as those in the top 10% of acute healthcare costs in the year prior to a person’s hospitalization in which they died. Results: Among 252,648 people who died in hospital, 25,264 were high cost users (10%), 112,506 were non-high cost users (44.5%) and 114,878 had no prior acute care use (45.5%). After adjustment for age and sex, high cost user status was associated with a 14% increased odds of receiving an invasive intervention, a 15% increased odds of having major surgery, and an 8% lower odds of receiving palliative care compared to non-high cost users, but opposite when compared to patients without prior healthcare use. Conclusions: Many patients receive aggressive elements of end-of-life care during the hospitalization in which they die and a substantial number do not receive palliative care. Understanding how this care differs between those who were previously high- and non-high cost users may provide an opportunity to improve end of life care for whom better care planning and provision ought to be an equal priority.

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Comparison of Palliative Care Delivery in the Last Year of Life Between Adults With Terminal Noncancer Illness or Cancer

Cited by 50 publications

References 51 publications

The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives

The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives

Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort

Association between high cost user status and end-of-life care in hospitalized patients: A national cohort study of patients who die in hospital

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