Palliative Care for Cancer Patients Near End of Life in Acute-Care Hospitals across Canada: A Look at the Inpatient Palliative Care Code

Abstract

Hospitals play an important role in the care of patients with advanced cancer: nearly half of all cancer deaths occur in acute-care settings. The need for increasing access to palliative care and related support services for patients with cancer in acute-care hospitals is therefore growing. Here, we examine how often and how early in their illness patients with cancer might be receiving palliative care services in the 2 years before their death in an acute-care hospital in Canada. The palliative care code from inpatient administrative databases was used as a proxy for receiving, or being referred for, palliative care. Currently, the palliative care code is the only data element routinely collected from patient charts that allows for the tracking of palliative care activity at a pan-Canadian level. Our findings suggest that most patients with cancer who die in an acute-care hospital receive a palliative designation; however, many of those patients are identified as palliative only in their final admission before death. Of the patients who received a palliative designation before their final admission, nearly half were identified as palliative less than 2 months before death. Findings signal that delivery of services within and between jurisdictions is not consistent, that the palliative care needs of some patients are being missed by physicians, and that palliative care is still largely seen as end-of-life care and is not recognized as an integral component of cancer care. Measuring the provision of system-wide palliative care remains a challenge because comprehensive national data about palliative care are not currently reported from all sectors. To advance measurement and reporting of palliative care in Canada, attention should be focused on collecting comparable data from regional and provincial palliative care programs that individually capture data about palliative care delivery in all health care sectors.

Nurses’ perceptions of and barriers to the optimal end‐of‐life care in hospitals: A cross‐sectional study

“…In response to factors which impeded optimal EOL care, nurses gave the highest ranking of being "too busy" in both nurses and doctors. Similar findings have also been reported as an important barrier to providing quality EOL care in Thailand (Mesukko, 2010), Canada (Tung et al, 2019), Australia (Raymond, Lee, & Bloomer, 2017) and a recent explanatory systematic review (Lund et…”

“…Canada (Tung et al, 2019), Australia (Raymond, Lee, & Bloomer, 2017) and a recent explanatory systematic review (Lund et al,…”

Hospital patients’ perspectives on what is essential to enable optimal palliative care: A qualitative study

“…The majority of expected deaths in high income countries occur in hospitals, [1][2][3][4][5][6][7] where optimal palliative care cannot be assured. 6,[8][9][10][11][12] People with palliative care needs are also often hospitalised within the last year of life, even if they don't die in this setting, [13][14][15][16] so hospital clinicians provide care intermittently to this population from diagnosis through to death.…”

How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers

“…Another Canadian study looking at inpatient palliative care code that identified patients who received or were referred to palliative care revealed that 76.8% of patients were only first identified as "palliative" in their final admission before death; for other patients receiving the designation before their final admission, nearly half were identified less than 2 months before death. 24 Some participants in our study also cautioned that a gradual normalization of MAiD discus sions, even if wellintended to promote patients' autonomy, may inadvertently move palliative care from being compassiondriven to process driven. 25 This can have important social and practice implications, as a wholeperson focus on patient emotions and suffering in their wider sociorelational context may allow HCPs to probe and clarify patient motivations, potential miscon ceptions, and needs, thereby providing tailored education and support.…”

“…Another Canadian study looking at inpatient palliative care code that identified patients who received or were referred to palliative care revealed that 76.8% of patients were only first identified as “palliative” in their final admission before death; for other patients receiving the designation before their final admission, nearly half were identified less than 2 months before death. 24 …”