Association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of end-of-life care: An investigation of cancer decedents in a cancer-designated hospital in Japan.

Abstract

39 Background: Palliative care has a positive effect on many clinical outcomes, yet most referrals to palliative care have occurred late. End-of-life (EOL) cancer care has become increasingly aggressive. There have been no studies investigating the association between early palliative care referrals and aggressive EOL care in Japan. Methods: This study was designed to explore the association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of EOL care by investigating cancer decedents. A retrospective cohort study in a cancer designated hospital in Japan. This study examined 266 consecutive cancer decedents. Inclusion criteria were as follows: (1) adults and (2) patients who died from cancer or causes related to cancer. Patients who died from causes unrelated to cancer were excluded. A total of 265 patients met the criteria. We explored the association between early referrals (>3 months before death) and inpatient hospice utilization and the relationship between the timing of referrals and aggressive EOL care measured by a composite score adapted from Earle et al. Results: Patients were divided into an early referral group (n=54) and a control group (n=211). The rate of inpatient hospice utilization was significantly higher in the early referral group (74% vs. 47%, P<0.001). While each of six indicators of aggressiveness of EOL care did not differ significantly, the composite score was significantly lower in the early referral group (1.91 ± 0.59 vs. 2.14 ± 0.78, P=0.040). Conclusions: Early palliative referrals were associated with more inpatient hospice utilization and less aggressive EOL care.