The association between palliative healthcare service provision and place of death: a population study of cancer patients


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Maria Kelly1,Katie O' Brien1,Ailish Hannigan2
1National Cancer Registry Ireland,2University of Limerick

Abstract

Background

Factors affecting where a patient dies are not limited to patient sociodemographic and clinical factors, but also characteristics of the health service where they receive care. There is a lack of empirical studies that systematically assess the influence of palliative healthcare service provision on place of death.

Method

We profiled cancer patients receiving specialist palliative care (SPC) with an analysis of place of death (PoD) using linked population data.  Incident invasive cancer, excluding non-melanoma skin cancer, in patients diagnosed from 1994-2016 in Ireland, who attended a cancer centre in 2016 and who died in 2016 were included. Patients were categorised based on having an indicator of an ‘SPC encounter’ or not in their hospital episode data. Patients were classified to one of eight geographical health regions based on their address at diagnosis. PoD was categorised from death certificates to ‘Home’, ‘Hospital’, ‘Hospice’, ‘Other’ and ‘Unknown’.   Descriptive statistics and logistic regression analyisis was used to examine factors associated with receiving SPC and PoD.

Results

We identified n=4139 cancer decedents for this study; 63% (n=2597) had an SPC encounter.  

Being younger, not married and from more deprived areas showed higher odds of an SPC encounter. After accounting for sociodemographic factors and relative to the most populous Eastern region, decedents in the Midland and the South Eastern regions were less likely to receive SPC, both regions with no SPC bed capacity.

Having an SPC encounter affected PoD; 43% of SPC recipients died in hospital versus 48% of non-recipients, 32% died in a hospice versus 16% while 18% died at home versus 28%.  SPC bed capacity by region contributed to the PoD variation.

Conclusion

A lack of regional inpatient hospice services impacts PoD in cancer patients who have had an SPC encounter in acute hospitals. This has implications for service commissioning and planning.