Abstract
BackgroundThe last year of life is one of the most resource-intensive periods for people with cancer. Very little population-based research has been conducted on end-of-life cancer care in the Australian health care setting. The objective of this program is to undertake a series of observational studies examining resource use, costs and quality of end-of-life care in a cohort of elderly cancer decedents using linked, routinely collected data.Methods/DesignThis study forms part of an ongoing cancer health services research program. The cohorts for the end-of-life research program comprise Australian Government Department of Veterans’ Affairs decedents with full health care entitlements, residing in NSW for the last 18 months of life and dying between 2005 and 2009. We used cancer and death registry data to identify our decedent cohorts and their causes of death. The study population includes 9,862 decedents with a cancer history and 15,483 decedents without a cancer history. The median age at death is 86 and 87 years in the cancer and non-cancer cohorts, respectively. We will examine resource use and associated costs in the last 6 months of life using linked claims data to report on health service use, hospitalizations, emergency department visits and medicines use. We will use best practice methods to examine the nature and extent of resource use, costs and quality of care based on previously published indicators. We will also examine factors associated with these outcomes.DiscussionThis will be the first Australian research program and among the first internationally to combine routinely collected data from primary care and hospital-based care to examine comprehensively end-of-life care in the elderly. The research program has high translational value, as there is limited evidence about the nature and quality of care in the Australian end-of-life setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0148-2) contains supplementary material, which is available to authorized users.
Highlights
The last year of life is one of the most resource-intensive periods for people with cancer
We identified five Australian studies in the systematic review [7,8,9,11,12] that focused on the use of specialist palliative care services, hospital admissions or emergency department presentations in a specific end-of-life period
Setting Australia has a publicly funded universal health care system entitling all Australian citizens and permanent residents to a range of subsidized health services. This includes free treatment in public hospitals and subsidized treatment in private hospitals. It includes a range of subsidized outpatient services including consultations with medical and selected health care professionals and medicines prescribed in hospitals and the community
Summary
End-of-life care is a high-priority research area for health policy and planning. The topic has recently been the subject of editorials and research articles in the highest ranking general medicine and cancer journals internationally [2,3]. The five papers reporting the results of research into end-of-life care in the Australian setting to date [7,8,9,11,12] have focused primarily on hospital services; our program will build on this work to provide a more comprehensive picture of end-of-life care This program is the first to apply quality of care markers of end-of-life care outside the North American setting. The strengths of this program lie in the use of best practice methods to examine comprehensive data holdings including medicines, hospital services and other health care services.
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