Is palliative care support associated with better quality end-of-life care indicators for patients with advanced cancer? A retrospective cohort study

ObjectivesThis study aimed to establish the association between timing and provision of palliative care (PC) and quality of end-of-life care indicators in a population of patients dying of cancer.SettingThis study uses linked cancer patient data from the National Cancer Registry, the electronic medi...

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Veröffentlicht in:BMJ open Jg. 8; H. 1; S. e018284
Hauptverfasser: Ziegler, Lucy E, Craigs, Cheryl L, West, Robert M, Carder, Paul, Hurlow, Adam, Millares-Martin, Pablo, Hall, Geoff, Bennett, Michael I
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England BMJ Publishing Group LTD 01.01.2018
BMJ Publishing Group
Schlagworte:
Aged
Aged, 80 and over
Cancer therapies
Cause of Death
Chemotherapy
Cohort analysis
Death
Electronic Health Records
Emergency Medical Services
England
Female
Hospice Care
Hospices
Hospital Mortality
Hospitalization
Humans
Male
Metastasis
Middle Aged
Narcotics
Neoplasms - mortality
Pain
Palliative Care
Patient admissions
Population
Primary care
Primary Health Care
Quality
Quality of Life
Retrospective Studies
Systematic review
Terminal Care - standards
Terminally Ill
Time Factors
United Kingdom > UK
England
end of life care
palliative care
transitions in cancer care
oncology
ISSN:2044-6055, 2044-6055
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Zusammenfassung:ObjectivesThis study aimed to establish the association between timing and provision of palliative care (PC) and quality of end-of-life care indicators in a population of patients dying of cancer.SettingThis study uses linked cancer patient data from the National Cancer Registry, the electronic medical record system used in primary care (SystmOne) and the electronic medical record system used within a specialist regional cancer centre. The population resided in a single city in Northern England.ParticipantsRetrospective data from 2479 adult cancer decedents who died between January 2010 and February 2012 were registered with a primary care provider using the SystmOne electronic health record system, and cancer was certified as a cause of death, were included in the study.ResultsLinkage yielded data on 2479 cancer decedents, with 64.5% who received at least one PC event. Decedents who received PC were significantly more likely to die in a hospice (39.4% vs 14.5%, P<0.005) and less likely to die in hospital (23.3% vs 40.1%, P<0.05), and were more likely to receive an opioid (53% vs 25.2%, P<0.001). PC initiated more than 2 weeks before death was associated with avoiding a hospital death (≥2 weeks, P<0.001), more than 4 weeks before death was associated with avoiding emergency hospital admissions and increased access to an opioid (≥4 weeks, P<0.001), and more than 33 weeks before death was associated with avoiding late chemotherapy (≥33 weeks, no chemotherapy P=0.019, chemotherapy over 4 weeks P=0.007).ConclusionFor decedents with advanced cancer, access to PC and longer duration of PC were significantly associated with better end-of-life quality indicators.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2017-018284