Quality of End-of-Life Cancer Care in Canada: A Retrospective Four-Province Study Using Administrative Health Care Data

Barbera, Lisa; Seow, Hsien; Sutradhar, Rinku; Chu, Anna; Fassbender, Konrad; McGrail, Kim; Lawson, Beverley; Liu, Y.; Pataky, Reka; Potapov, Alexey

doi:10.3747/co.22.2636

Cited by 44 publications

(56 citation statements)

References 33 publications

(44 reference statements)

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“…In England, about 46.7% of all deaths occur in hospital (2015 data) with a decrease of 11.2% in 10 years, while in the United States, 28.8% of deaths occurred in hospital for EOL cancer patients in 2003 with a 14.4% decrease in 7 years . Higher rates of cancer patients dying in a hospital are also observed in Canada, where on average 54% patients died in hospital . Location of death not only influences the dying experience but also affects healthcare utilization and costs .…”

Section: Introductionmentioning

confidence: 99%

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

Ferrè

Vinci

Murante

2019

Health Planning & Management

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Summary Supportive and palliative care at the end of life (EOL) is a core component of health systems. Providing care at the EOL may require the interaction of several care providers working in different settings including nursing homes, home care, hospices, and hospitals. This work aims to (a) provide evidence on the performance of EOL care for cancer patients across healthcare organizations, with a focus on the place of care, aggressive treatments, opioids, and the place of death and (b) analyze factors associated with dying in hospital. A population‐based retrospective study was performed using administrative data from Tuscany region (Italy). Thirteen thousand sixty‐six cancer patients who died in 2016 were considered. There is a marked variability in EOL care within regional areas, with the multilevel logistic regression highlighting a greater likelihood of dying in hospital for patients who were admitted to intensive care units or previously hospitalized. There is a lower probability of dying in acute care setting for patients assisted in hospices and in both hospital and hospices/home care and for patients treated with opioids. This intraregional variation highlights the need to improve EOL planning and rethink the delivery of supportive/palliative care. Further investigations on the preferences of patients may lead to more understanding.

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Section: Introductionmentioning

confidence: 99%

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

Ferrè

Vinci

Murante

2019

Health Planning & Management

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“…Those outcomes were selected because, in prior studies, a shorter interval from diagnosis to death [16][17][18][19]22,23 and in-hospital death 18,20,21 were indicators of lower rates of access to out-of-hospital palliative support. Other outcome indicators of the quality of community-based palliative care at end of life are timely enrolment in specialized palliative care 16,20,23 , no or few days in hospital in the last month of life 18,22 , and minimal use of the emergency department [18][19][20][21][22] . Receiving palliative radiation [16][17][18][19][20]23 and home care [20][21][22] have also been used as indicators of quality end-of-life care.…”

Section: Strengths Limitations and Recommendationsmentioning

confidence: 99%

“…Receiving palliative radiation [16][17][18][19][20]23 and home care [20][21][22] have also been used as indicators of quality end-of-life care. Access to, and continuity of, primary care, the use of medical oncology and chemotherapy [18][19][20]22 , and being a nursing home resident 19,23,30 are also relevant. Socioeconomic and distance indicators of inequity should be investigated by linking the postal code of residence at death to census data 17,19,22,23,45 because a meta-analysis showed that the benefit from navigation is greatest for the most vulnerable individuals 46 .…”

Section: Strengths Limitations and Recommendationsmentioning

confidence: 99%

“…Other outcome indicators of the quality of community-based palliative care at end of life are timely enrolment in specialized palliative care 16,20,23 , no or few days in hospital in the last month of life 18,22 , and minimal use of the emergency department [18][19][20][21][22] . Receiving palliative radiation [16][17][18][19][20]23 and home care [20][21][22] have also been used as indicators of quality end-of-life care. Access to, and continuity of, primary care, the use of medical oncology and chemotherapy [18][19][20]22 , and being a nursing home resident 19,23,30 are also relevant.…”

Section: Strengths Limitations and Recommendationsmentioning

confidence: 99%

“…Although few studies of navigation in relation to palliative and end-of-life care have been reported 5,8 , the population-based study design for investigating care for people at the end of life has been well established in Nova Scotia and elsewhere [16][17][18][19][20][21][22][23] . Nova Scotia is therefore an ideal setting to investigate use of navigation by people with cancer who are in their last phase of life.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

Park¹,

Johnston

Urquhart³

et al. 2018

Current Oncology

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Population-Based Quality Indicators for End-of-Life Cancer Care

et al. 2020

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Improving the quality of cancer care is an international priority. Population-based quality indicators (QIs) are key to this process yet remain almost exclusively used for evaluating care during the early, often curative, stages of disease.OBJECTIVES To identify all existing QIs for the care of patients with cancer who have advanced disease and/or are at the end of life and to evaluate each indicator's measurement properties and appropriateness for use.EVIDENCE REVIEW For this systematic review, 5 electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Library) were searched from inception through February 4, 2019, for studies describing the development, review, and/or testing of QIs for the care of patients with cancer who have advanced disease and/or are at the end of life. For each QI identified, descriptive information was extracted and 6 measurement properties (acceptability, evidence base, definition, feasibility, reliability, and validity) were assessed using previously established criteria, with 4 possible ratings: positive, intermediate, negative, and unknown. Ratings were collated and each QI classified as appropriate for use, inappropriate for use, or of limited testing. Among the QIs determined as appropriate for use, a recommended shortlist was generated by excluding those that were specific to patient subgroups and/or care settings; related QIs were identified, and the indicator with the highest rating was retained.FINDINGS The search yielded 7231 references, 35 of which (from 28 individual studies) met the eligibility criteria. Of 288 QIs extracted (260 unique), 103 (35.8%) evaluated physical aspects of care and 109 (37.8%) evaluated processes of care. Quality indicators relevant to psychosocial (18 [6.3%]) or spiritual and cultural (3 [1.0%]) care domains were limited. Eighty QIs (27.8%) were determined to be appropriate for use, 116 (40.3%) inappropriate for use, and 92 (31.9%) of limited testing. The measurement properties with the fewest positive assessments were acceptability (38 [13.2%]) and validity (63 [21.9%]). Benchmarking data were reported for only 16 QIs (5.6%). The final 15 recommended QIs came from 6 studies. CONCLUSIONS AND RELEVANCEThe findings suggest that only a small proportion of QIs developed for the care of patients with cancer who have advanced disease and/or are at the end of life have received adequate testing and/or are appropriate for use. Further testing may be needed, as is research to establish benchmarking data and to expand QIs relevant to psychosocial, cultural, and spiritual care domains.

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Quality of End-of-Life Cancer Care in Canada: A Retrospective Four-Province Study Using Administrative Health Care Data

Abstract: BackgroundThe quality of data comparing care at the end of life (eol) in cancer patients across Canada is poor.

Cited by 44 publications

References 33 publications

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

Population-Based Quality Indicators for End-of-Life Cancer Care

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