Effectiveness of palliative care services: A population-based study of end-of-life care for cancer patients.
Palliat Med
; 32(8): 1344-1352, 2018 09.
Article
de En
| MEDLINE
| ID: mdl-29886795
ABSTRACT
BACKGROUND:
Multiple studies demonstrate substantial utilization of acute hospital care and, potentially excessive, intensive medical and surgical treatments at the end-of-life.AIM:
To evaluate the relationship between the use of home and facility-based hospice palliative care for patients dying with cancer and service utilization at the end of life.DESIGN:
Retrospective, population-level study using administrative databases. The effect of palliative care was analyzed between coarsened exact matched cohorts and evaluated through a conditional logistic regression model. SETTING/PARTICIPANTS:
The study was conducted on the cohort of 34,357 patients, resident in Emilia-Romagna Region, Italy, admitted to hospital with a diagnosis of metastatic or poor-prognosis cancer during the 6 months before death between January 2013 and December 2015.RESULTS:
Patients who received palliative care experienced significantly lower rates of all indicators of aggressive care such as hospital admission (odds ratio (OR) = 0.05, 95% confidence interval (CI) 0.04-0.06), emergency department visits (OR = 0.23, 95% CI 0.21-0.25), intensive care unit stays (OR = 0.29, 95% CI 0.26-0.32), major operating room procedures (OR = 0.22, 95% CI 0.21-0.24), and lower in-hospital death (OR = 0.11, 95% CI 0.10-0.11). This cohort had significantly higher rates of opiate prescriptions (OR = 1.27, 95% CI 1.21-1.33) ( p < 0.01 for all comparisons).CONCLUSION:
Use of palliative care at the end of life for cancer patients is associated with a reduction of the use of high-cost, intensive services. Future research is necessary to evaluate the impact of increasing use of palliative care services on other health outcomes. Administrative databases linked at the patient level are a useful data source for assessment of care at the end of life.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Soins palliatifs
/
Soins terminaux
/
Accompagnement de la fin de la vie
/
Tumeurs
Type d'étude:
Etiology_studies
/
Evaluation_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Limites:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Pays/Région comme sujet:
Europa
Langue:
En
Journal:
Palliat Med
Sujet du journal:
SERVICOS DE SAUDE
Année:
2018
Type de document:
Article
Pays d'affiliation:
Italie