Abstract
Palliative care improves health outcomes, but studies of the differences in the delivery of palliative care to patients with different types of serious illness are lacking. To examine the delivery of palliative care among adults in their last year of life who died of terminal noncancer illness compared with those who died of cancer. This population-based cohort study used linked health administrative data of adults who received palliative care in their last year of life and died between January 1, 2010, and December 31, 2017, in Ontario, Canada. Cause of death (chronic organ failure, dementia, or cancer). Components of palliative care delivery, including timing and location of initiation, model of care, physician mix, care settings, and location of death. A total of 145 709 adults received palliative care (median age, 78 years; interquartile range, 67-86 years; 50.7% female); 21 054 died of chronic organ failure (4704 of heart failure, 5715 of chronic obstructive pulmonary disease, 3785 of end-stage kidney disease, 579 of cirrhosis, and 6271 of stroke), 14 033 died of dementia, and 110 622 died of cancer. Palliative care was initiated earlier (>90 days before death) in patients with cancer (32 010 [28.9%]) than in those with organ failure (3349 [15.9%]; absolute difference, 13.0%) or dementia (2148 [15.3%]; absolute difference, 13.6%). A lower proportion of patients with cancer had palliative care initiated in the home (16 088 [14.5%]) compared with patients with chronic organ failure (6904 [32.8%]; absolute difference, -18.3%) or dementia (3922 [27.9%]; absolute difference, -13.4%). Patients with cancer received palliative care across multiple care settings (92 107 [83.3%]) more often than patients with chronic organ failure (12 061 [57.3%]; absolute difference, 26.0%) or dementia (7553 [53.8%]; absolute difference, 29.5%). Palliative care was more often delivered to patients with cancer (80 615 [72.9%]) using a consultative or specialist instead of a generalist model compared with patients with chronic organ failure (9114 [43.3%]; absolute difference, 29.6%) or dementia (5634 [40.1%]; absolute difference, 32.8%). Patients with cancer (42 718 [38.6%]) received shared palliative care more often from general practitioners and physicians with subspecialty training, compared with patients with chronic organ failure (3599 [17.1%]; absolute difference, 21.5%) or dementia (1989 [14.2%]; absolute difference, 24.4%). In this cohort study, there were substantial patient- and practitioner-level differences in the delivery of palliative care across distinct types of serious illness. These patient- and practitioner-level differences have important implications for the organization and scaled implementation of palliative care programs, including enhancement of practitioner education and training and improvements in equitable access to care across all settings.
Highlights
Palliative care improves quality of life, reduces symptom burden and unwanted health care use, and helps patients die in their preferred location.[1,2,3,4,5,6] Palliative care is the active holistic care of people and their families experiencing suffering because of serious illness, especially near the end of life
Patients dying of chronic organ failure had lower odds of palliative care initiation at 91 days or more and between 31 and 90 days relative to initiation at 30 days or less before death compared with patients with cancer
Patients dying of dementia had a lower odds of palliative care initiation at 91 days or more and between 31 and 90 days relative to initiation at 30 days or less before death compared with patients with cancer (Table 3)
Summary
Palliative care improves quality of life, reduces symptom burden and unwanted health care use, and helps patients die in their preferred location.[1,2,3,4,5,6] Palliative care is the active holistic care of people and their families experiencing suffering because of serious illness, especially near the end of life It focuses on the prevention, early identification, assessment, and management of physical issues, including pain and other distressing symptoms, psychological distress, spiritual distress, and social needs.[7] studies[1,4,8,9,10,11] contrasting palliative care for patients with cancer and those with terminal noncancer illness report disparities in access and differences in the magnitude of its associated benefits. Patients who received palliative care in the home from specialist palliative care practitioners had increased odds of a home death, a place where most patients prefer to die
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