Objectives To explore differences in severe symptom outcomes for palliative care patients receiving hospital care compared with those receiving care at home.
Methods Change in symptom distress from the start of an episode of palliative care to just prior to death was measured for 25 679 patients who died under the care of a hospital or home-based palliative care team between January 2015 and December 2016. Logistic regression models controlled for differences between hospital and home and enabled a comparison of the number of severe symptoms just prior to death.
Results All symptoms improved and over 85% of all patients had no severe symptoms prior to death. Pain control illustrates this with 7.4% of patients reporting severe pain distress at episode start and 2.5% just prior to death. When comparing all symptom outcomes by place of death, hospital patients are 3.7 times more likely than home patients to have no severe symptoms.
Conclusion Symptom outcomes are better for hospital patients. Patients at home have less improvement overall and some symptoms get worse. Reasons for the difference in outcomes by hospital and home are multifactorial and must be considered in relation to the patient’s right to choose their place of care.
- palliative care
- patient choice
- patient outcome
- patient reported outcome measures
- Home care
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Funding This study was funded by Department of Health, Australian Government.
Competing interests None declared.
Patient consent Not required.
Ethics approval Ethical approval by the Human Research Ethics Committee, University of Wollongong / Illawarra Shoalhaven Local Health District, ID: 2006/045.
Provenance and peer review Not commissioned; externally peer reviewed.
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