Effectiveness of palliative care services: A population-based study of end-of-life care for cancer patients

• Published in: Palliative medicine Vol. 32; no. 8; pp. 1344 - 1352
• Main Authors: De Palma, Rossana, Fortuna, Daniela, Hegarty, Sarah E, Louis, Daniel Z, Melotti, Rita Maria, Moro, Maria Luisa
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.09.2018; Sage Publications Ltd
• Subjects: Cancer; Clinical outcomes; Confidence intervals; Cost analysis; Death & dying; Emergency services; End of life decisions; Health status; Hospice care; Hospitalization; Intensive care; Medical diagnosis; Medical prognosis; Operating theatres; Palliative care; Patients; Population-based studies; Prescription drugs; retrospective studies; quality of health care; advanced cancer; health resources; Palliative care; Italy; terminal care; humans
• ISSN: 0269-2163; 1477-030X
• DOI: 10.1177/0269216318778729

Background: Multiple studies demonstrate substantial utilization of acute hospital care and, potentially excessive, intensive medical and surgical treatments at the end-of-life. Aim: To evaluate the relationship between the use of home and facility-based hospice palliative care for patients dying with cancer and service utilization at the end of life. Design: Retrospective, population-level study using administrative databases. The effect of palliative care was analyzed between coarsened exact matched cohorts and evaluated through a conditional logistic regression model. Setting/participants: The study was conducted on the cohort of 34,357 patients, resident in Emilia-Romagna Region, Italy, admitted to hospital with a diagnosis of metastatic or poor-prognosis cancer during the 6 months before death between January 2013 and December 2015. Results: Patients who received palliative care experienced significantly lower rates of all indicators of aggressive care such as hospital admission (odds ratio (OR) = 0.05, 95% confidence interval (CI): 0.04–0.06), emergency department visits (OR = 0.23, 95% CI: 0.21–0.25), intensive care unit stays (OR = 0.29, 95% CI: 0.26–0.32), major operating room procedures (OR = 0.22, 95% CI: 0.21–0.24), and lower in-hospital death (OR = 0.11, 95% CI: 0.10–0.11). This cohort had significantly higher rates of opiate prescriptions (OR = 1.27, 95% CI: 1.21–1.33) (p < 0.01 for all comparisons). Conclusion: Use of palliative care at the end of life for cancer patients is associated with a reduction of the use of high-cost, intensive services. Future research is necessary to evaluate the impact of increasing use of palliative care services on other health outcomes. Administrative databases linked at the patient level are a useful data source for assessment of care at the end of life.