Palliative care for cancer patients near end of life in acute-care hospitals across Canada: a look at the inpatient palliative care code.

Jasmine Tung,C Louzado,A Sinnarajah,D Dudgeon,J Niu,R Rahal,J Chadder

doi:10.3747/co.26.4563

Jasmine Tung, C Louzado + Show 5 more

Open Access

https://doi.org/10.3747/co.26.4563

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Abstract

Hospitals play an important role in the care of patients with advanced cancer: nearly half of all cancer deaths occur in acute-care settings. The need for increasing access to palliative care and related support services for patients with cancer in acute-care hospitals is therefore growing. Here, we examine how often and how early in their illness patients with cancer might be receiving palliative care services in the 2 years before their death in an acute-care hospital in Canada. The palliative care code from inpatient administrative databases was used as a proxy for receiving, or being referred for, palliative care. Currently, the palliative care code is the only data element routinely collected from patient charts that allows for the tracking of palliative care activity at a pan-Canadian level. Our findings suggest that most patients with cancer who die in an acute-care hospital receive a palliative designation; however, many of those patients are identified as palliative only in their final admission before death. Of the patients who received a palliative designation before their final admission, nearly half were identified as palliative less than 2 months before death. Findings signal that delivery of services within and between jurisdictions is not consistent, that the palliative care needs of some patients are being missed by physicians, and that palliative care is still largely seen as end-of-life care and is not recognized as an integral component of cancer care. Measuring the provision of system-wide palliative care remains a challenge because comprehensive national data about palliative care are not currently reported from all sectors. To advance measurement and reporting of palliative care in Canada, attention should be focused on collecting comparable data from regional and provincial palliative care programs that individually capture data about palliative care delivery in all health care sectors.

Highlights

In most developed countries, a trend toward more patients with chronic disease dying in hospital is observed[1]
Of patients with cancer in Canada who received a palliative care code in an inpatient setting, 76.8% were first designated as palliative during their final admission before death (Figure 2)
The palliative care code is the only data element routinely collected from patient charts that allows for the tracking of palliative care activity at a pan-Canadian level

Summary

Introduction

A trend toward more patients with chronic disease dying in hospital is observed[1]. Because hospitals play an important role in the care of patients with advanced disease, the need for increased access to palliative care and related support services for patients with cancer in acute-care hospitals is growing. Palliative care aims to provide relief from the physical symptoms associated with a life-threatening illness and support for associated psychosocial, spiritual, and cultural needs, all aimed at improving quality of life for patients and families alike[3]. Most palliative care can be delivered in settings other than acute-care hospitals (for example, home, hospices, and long-term care facilities) by a range of providers, including family doctors, nurses, and other health care practitioners[5]. A population-based study found that, of patients with cancer receiving palliative care, 84.9% received care in acute-care hospitals[6]. Palliative care was shown to be the main reason for hospitalization for more than half of all patients with

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