Abstract
Background
Palliative care (PC) has been shown to improve outcomes for individuals at the end of life. Despite this, many Canadians do not receive PC prior to death. The present study examines the receipt of inpatient PC and its association with location of death, as well as with admission to intensive care units (ICUs) and use of alternate level of care (ALC) beds in hospital in the last 30 days of life.
Data and methods
The study sample is a retrospective cohort of adult Canadians (aged 19 and older) who died between April 1, 2010, and December 31, 2014. Deaths were ascertained from the Canadian Vital Statistics Database and linked to hospitalizations records in the Discharge Abstract Database to identify the receipt of inpatient PC.
Results
More than half (57.7%) of Canadian adults died in hospital, with only 12.6% receiving any inpatient PC in the year prior to death, and 1.7% receiving a pre-terminal PC designation (i.e., PC initiated prior to the last 30 days of life). In the adjusted analyses, receipt of any inpatient PC was associated with a higher likelihood of death in hospital but lower odds of ICU admission. Pre-terminal PC was associated with lower odds of death in hospital, ICU admission and ALC bed use.
Interpretation
This study offers new insights into the association between inpatient PC and outcomes at the end of life among Canadians. Future studies could expand on these observations to further understanding of the role of inpatient PC in the end-of-life experience for different populations in Canada.
Keywords
palliative care, end of life, administrative data, health outcomes, record linkage
DOI: https://www.doi.org/10.25318/82-003-x202001000001-eng
Findings
Canada continues to have a hospital-centric care system for those who are dying, despite the preference of most individuals to die in their community and other home-like settings. In 2015, 58% of decedents in Canada were hospitalized more than once in their last year of life and 61% of Canadians died in hospital. Under a hospital-centric system, the health care costs associated with dying are high. Despite the prominence of hospital care near the end of life, little is known about the characteristics of those who are admitted to hospital during this period and the types of inpatient care being provided. Hospitalizations in the final year of life may provide an opportunity to initiate palliative care (PC) or continue a PC treatment plan established prior to hospitalization. [Full article]
Authors
Amy T. Hsu (ahsu@ohri.ca) is with the Bruyère Research Institute, the Department of Family Medicine at the University of Ottawa, and the Clinical Epidemiology Program at the Ottawa Hospital Research Institute. Rochelle E. Garner (rochelle.garner@canada.ca) is with the Health Analysis Division at Statistics Canada in Ottawa, Ontario.
What is already known on the subject?
- While most Canadians die of causes with predictable trajectories, many do not receive palliative care or adequate support prior to death.
- Receipt of palliative care has been associated with beneficial end-of-life outcomes, including lower health care costs, acute care use and improved patient satisfaction with care.
- Hospitalizations are common as individuals approach death, and could serve as a care inflection point and an opportunity to initiate palliative care for Canadians in their last year of life.
What does this study add?
- Decedents’ location of death (i.e., in hospital or outside of hospital) and receipt of inpatient palliative care varied greatly across provinces.
- Few Canadians receive palliative care in inpatient settings prior to their terminal hospitalization (i.e., the inpatient care episode in which the patient died).
- In adjusted analyses, receipt of any inpatient palliative care was associated with a higher likelihood of death in hospital but lower odds of an intensive care admission. However, receipt of pre-terminal palliative care (i.e., receipt of inpatient care prior to the last 30 days of life) was associated with lower odds of death in hospital, intensive care admission and alternate level of care bed use.
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