Dataset Information

End-of-life outcomes with or without early palliative care: a propensity score matched, population-based cancer cohort study.

ABSTRACT:

Objectives

To investigate whether cancer decedents who received palliative care early (ie, >6 months before death) and not-early had different risk of using hospital care and supportive home care in the last month of life.

Design/setting

We identified a population-based cohort of cancer decedents between 2004 and 2014 in Ontario, Canada using linked administrative data. Analysis occurred between August 2017 to March 2019.

Participants

We propensity-score matched decedents on receiving early or not-early palliative care using billing claims. We created two groups of matched pairs: one that had Resident Assessment Instrument (RAI) home care assessments in the exposure period (Yes-RAI group) and one that did not (No-RAI group) to control for confounders uniquely available in the assessment, such as health instability and pain. The outcomes were the absolute risk difference between matched pairs in receiving hospital care, supportive home care or hospital death.

Results

In the No-RAI group, we identified 36?238 pairs who received early and not-early palliative care. Those in the early palliative care group versus not-early group had a lower absolute risk difference of dying in hospital (-10.0%) and receiving hospital care (-10.4%) and a higher absolute risk difference of receiving supportive home care (23.3%). In the Yes-RAI group, we identified 3586 pairs, where results were similar in magnitude and direction.

Conclusions

Cancer decedents who received palliative care earlier than 6?months before death compared with those who did not had a lower absolute risk difference of receiving hospital care and dying in hospital, and an increased absolute risk difference of receiving supportive home care in the last month of life.

SUBMITTER: Seow H

PROVIDER: S-EPMC7883853 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

End-of-life outcomes with or without early palliative care: a propensity score matched, population-based cancer cohort study.

Seow Hsien H Sutradhar Rinku R Burge Fred F McGrail Kimberlyn K Guthrie Dawn M DM Lawson Beverley B Oz Urun Erbas UE Chan Kelvin K Peacock Stuart S Barbera Lisa L

BMJ open 20210212 2

<h4>Objectives</h4>To investigate whether cancer decedents who received palliative care early (ie, >6 months before death) and not-early had different risk of using hospital care and supportive home care in the last month of life.<h4>Design/setting</h4>We identified a population-based cohort of cancer decedents between 2004 and 2014 in Ontario, Canada using linked administrative data. Analysis occurred between August 2017 to March 2019.<h4>Participants</h4>We propensity-score matched decedents o ...[more]

PMID: 33579764

Similar Datasets

Project description:BackgroundAccess to hospice palliative care may improve quality of life, reduce the use of potentially aggressive end-of-life care and allow for death to occur outside of an acute care hospital. The aim of this study was to examine the impact of an ambulatory hospice palliative care program on end-of-life care compared to care received by a matched control group of deceased patients.MethodsThis retrospective study included patients who received hospice palliative care through the Symptom Management Program in Sudbury, Ontario, during 2012-2015. Using linked administrative health records, we defined a propensity-matched control group and derived 4 previously defined variables associated with aggressive end-of-life care (chemotherapy received in the last 2 wk of life, > 1 emergency department visit within 30 d of death, > 1 hospital admission within 30 d of death and at least 1 intensive care unit admission within 30 d of death). We also examined place of death. We measured family/caregiver satisfaction with care 3 months after the patient's death using the FAMCARE questionnaire.ResultsOf 914 eligible decedents enrolled in the Symptom Management Program, 754 (82.5%) were matched. Receiving care through the program was protective for most measures of aggressive end-of-life care (absolute risk reduction [ARR] 12.73, 95% confidence interval [CI] 12.65-12.81 for any end-of-life care outcome) and death in an acute care setting (ARR 19.89, 95% CI 19.78-20.00). Of the 450 family caregivers invited to complete the FAMCARE questionnaire, 190 (42.2%) returned completed surveys; following data linkage and matching, 96 (21.3%) were available for analysis. Satisfaction with care received within the program appeared high (mean total score 85.72/100).InterpretationProvision of hospice palliative care through this ambulatory program was associated with lower use of aggressive end-of-life care and death outside of an acute care hospital. Improving access could be expected to provide positive benefits at the individual and system level.

Dataset Information

End-of-life outcomes with or without early palliative care: a propensity score matched, population-based cancer cohort study.

Objectives

Design/setting

Participants

Results

Conclusions

Publications

End-of-life outcomes with or without early palliative care: a propensity score matched, population-based cancer cohort study.

Similar Datasets

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