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Effect of integrated palliative care on the quality of end-of-life care: retrospective analysis of 521 cancer patients
  1. Isabelle Colombet1,2,3,
  2. Vincent Montheil3,
  3. Jean-Philippe Durand4,
  4. Florence Gillaizeau1,2,
  5. Ralph Niarra2,
  6. Cécile Jaeger3,
  7. Jérôme Alexandre1,4,
  8. François Goldwasser1,4 and
  9. Pascale Vinant3
  1. 1Université Paris Descartes, Sorbonne Paris Cité, Public Health Paris, France
  2. 2INSERM, Centre d’Investigation Épidémiologique 4, Paris, France
  3. 3Palliative Medicine, Cochin Teaching Hospital, AP-HP, Paris, France
  4. 4Medical Oncology, Cochin Teaching Hospital, AP-HP, Paris, France
  1. Correspondence to Isabelle Colombet, Unité Fonctionnelle de Médecine Palliative, Hôpital Cochin, 27, Rue du Faubourg Saint-Jacques, 75679 PARIS Cedex 14, Paris, France; isabelle.colombet{at}parisdescartes.fr

Abstract

Objective To examine the impact of oncologist awareness of palliative care (PC), the intervention of the PC team (PCT) and multidisciplinary decision-making on three quality indicators of end-of-life (EOL) care.

Setting Cochin Academic Hospital, Paris, 2007–2008.

Design and participants A 521 decedent case series study nested in a cohort of 735 metastatic cancer patients previously treated with chemotherapy. Indicators were location of death, number of emergency room (ER) visits in last month of life and chemotherapy administration in last 14 days of life. Multivariable logistic regression models were used to estimate associations between indicators and oncologist's awareness of PC, PCT intervention and case discussions at weekly onco-palliative meetings (OPMs).

Results 58 (11%) patients died at home, 45 (9%) in an intensive care unit or ER, and 253 (49%) in an acute care hospital; 185 (36%) patients visited the ER in last month of life and 75 (14%) received chemotherapy in last 14 days of life. Only the OPM (n=179, 34%) independently decreases the odds of receiving chemotherapy in last 14 days of life (OR 0.5, 95% CI 0.2 to 0.9) and of dying in an acute care setting (0.3, 0.1 to 0.5). PCT intervention (n=300, 58%) did not independently improve any indicators. Among patients seen by the PCT, early PCT intervention had no impact on indicators, whereas the OPM reduced the odds of persistent chemotherapy in the last 14 days of life.

Conclusion Multidisciplinary decision-making with oncologists and the PCT is the most critical parameter for improving EOL care.

https://doi.org/10.1136/bmjspcare-2011-000157

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    Footnotes

    • Funding This research was supported by the Foundation Martine Midy through a grant to VM.

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.