Abstract
BackgroundTen percent of non-sudden deaths in the Netherlands occur in inpatient hospice facilities. To investigate differences between patients who are admitted to inpatient hospice care or not following application, how diagnoses compare to the national population, characteristics of application, and associations with being admitted to inpatient hospice care or not.MethodsData from a database representing over 25 % of inpatient hospice facilities in the Netherlands were analysed. The study period spanned the years 2007–2012. Multivariate regression analyses were performed to study associations between demographic and application characteristics, and admittance.ResultsTen thousand two hundred fifty-four patients were included. 84.1 % of patients applying for inpatient hospice care had cancer compared to 37.0 % of deaths nationally. 52.4 % of applicants resided in hospital at the time of admission. Most frequent reasons for application were the wish to die in an inpatient hospice facility (70.5 %), needing intensive care or support (52.2 %), relieving caregivers (41.4 %) and needing pain/symptom control (39.9 %). Living alone (OR 1.68, 95 % CI 1.46–1.94), having cancer (OR 1.40, 95 % CI 1.11–1.76), relieving caregivers (OR 1.18, 95 % CI 1.01–1.38), needing pain/symptom control (OR1.72, 95 % CI 1.46–2.03) wanting inpatient hospice care until death (vs respite care) (OR 3.59, 95 % CI 2.11–6.10), wanting to be admitted as soon as possible (OR 1.64, 95 % CI 1.42–1.88), and being referred by a primary care professional (OR 1.36, 95 % CI 1.17–1.59) were positively associated with being admitted. Wishing to die in an inpatient hospice facility was negatively associated with being admitted (OR 0.85, 95 % CI 0.72–1.00).ConclusionsThis study suggests that when applying for inpatient hospice care, patients who seem most urgently in need of inpatient hospice care are more frequently admitted. However, non-cancer patients seem to be an under-represented population. Staff should consider application based on need for palliation, irrespective of diagnosis.
Highlights
Ten percent of non-sudden deaths in the Netherlands occur in inpatient hospice facilities
This paper aims to investigate the differences between the populations who are admitted to inpatient hospice facilities or not following application, and how the spread of diagnoses compares to the national population at the end of life in terms of the characteristics of people who apply for care in inpatient hospice facilities
The result that the most frequent reason for not being admitted to inpatient hospice facilities is the death of the patient suggests that it may have been beneficial to consider applying for inpatient hospice care earlier on for at least part of this group
Summary
Ten percent of non-sudden deaths in the Netherlands occur in inpatient hospice facilities. European data have shown an imbalance in inpatient hospice use for certain groups when compared with the national average, with cancer patients consistently being found to be more likely to receive specialist palliative care (including in inpatient hospice facilities) than other groups such as patients with lung disease or heart failure [6]. Demographic differences have been found to have an influence, with the oldest-old being less likely to receive specialist care at the end of life [7]. This unequal distribution of the use of inpatient hospice facilities may be related to different levels of need, but may represent unequal levels of access [8]
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