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- Title
Association between Inappropriate End-of-Life Cancer Care and Specialist Palliative Care: A Retrospective Observational Study in Two Acute Care Hospitals.
- Authors
Boddaert, Manon S.; Fransen, Heidi P.; de Nijs, Ellen J. M.; van Gerven, Dagmar; Spierings, Leontine E. A.; Raijmakers, Natasja J. H.; van der Linden, Yvette M.
- Abstract
Simple Summary: A substantial number of patients with cancer receive inappropriate end-of-life care. Improving the quality of end-of-life care is a priority for both patients and their families. Palliative care has been demonstrated to improve the quality of life of patients with a life-threatening illness or frailty. The aim of our retrospective study was to assess whether cancer patients who were provided with specialist palliative care more than a month before their death were less likely to receive inappropriate end-of-life care than patients who were not. We analysed the hospital administrative data of 2603 deceased patients with cancer and found that 690 patients (27%) received potentially inappropriate care in their last month of life. Specialist palliative care was provided to 359 patients (14%). The likelihood for them to receive inappropriate end-of-life care was 45% lower than for patients who were not provided with specialist palliative care. A substantial number of patients with life-threatening illnesses like cancer receive inappropriate end-of-life care. Improving their quality of end-of-life care is a priority for patients and their families and for public health. To investigate the association between provision, timing, and initial setting of hospital-based specialist palliative care and potentially inappropriate end-of-life care for patients with cancer in two acute care hospitals in the Netherlands, we conducted a retrospective observational study using hospital administrative databases. All adults diagnosed with or treated for cancer in the year preceding their death in 2018 or 2019 were included. The main exposure was hospital-based specialist palliative care initiated >30 days before death. The outcome measures in the last 30 days of life were six quality indicators for inappropriate end-of-life care (≥2 ED-visits, ≥2 hospital admissions, >14 days hospitalization, ICU-admission, chemotherapy, hospital death). We identified 2603 deceased patients, of whom 14% (n = 359) received specialist palliative care >30 days before death (exposure group). Overall, 27% (n = 690) received potentially inappropriate end-of-life care: 19% in the exposure group, versus 28% in the non-exposure group (p < 0.001). The exposure group was 45% less likely to receive potentially inappropriate end-of-life care (AOR 0.55; 95% CI 0.41 to 0.73). Early (>90 days) and late (≤90 and >30 days) initiation of specialist palliative care, as well as outpatient and inpatient initiation, were all associated with less potentially inappropriate end-of-life care (AOR 0.49; 0.62; 0.32; 0.64, respectively). Thus, timely access to hospital-based specialist palliative care is associated with less potentially inappropriate end-of-life care for patients with cancer. The outpatient initiation of specialist palliative care seems to enhance this result.
- Subjects
HOSPITALS; TERMINAL care; SCIENTIFIC observation; RETROSPECTIVE studies; CANCER patients; CRITICAL care medicine; QUALITY of life; DESCRIPTIVE statistics; QUALITY assurance; HOSPITAL care; DECISION making in clinical medicine; CANCER patient medical care; PALLIATIVE treatment
- Publication
Cancers, 2024, Vol 16, Issue 4, p721
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16040721