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Palliative care for non-cancer conditions in primary care: a time trend analysis in the UK (2009–2014)
  1. Amy Gadoud1,
  2. Eleanor Kane2,
  3. Steven Edward Oliver3,
  4. Miriam J Johnson4,
  5. Una Macleod5 and
  6. Victoria Allgar3
  1. 1Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
  2. 2Health Sciences, University of York, York, North Yorkshire, UK
  3. 3Department of Health Sciences, University of York and Hull York Medical School, York, UK
  4. 4Wolfson Palliative Care Research Centre, University of Hull and Hull York Medical School, Hull, UK
  5. 5University of Hull and Hull York Medical School, Hull, UK
  1. Correspondence to Dr Amy Gadoud, Division of Health Research C83, International Observatory on End of Life Care, Lancaster University Faculty of Health and Medicine, Lancaster LA1 4YD, UK; a.gadoud{at}lancaster.ac.uk

Abstract

Objectives While guidelines recommend palliative care in non-cancer conditions, this has not been widely implemented. We examined whether the recording of a palliative care approach and the numbers of hospital deaths for deceased patients with heart failure, dementia, chronic obstructive pulmonary disease (COPD) and cancer have changed since the UK End-of-Life Care Strategy was introduced.

Methods We conducted sequential cross-sectional studies of decedents within the UK’s Clinical Practice Research Datalink and Hospital Episode Statistics. All adults with a primary care record of COPD (n=5426), dementia (n=7339), heart failure (n=6409) or cancer (n=18 668) who died during three 1 year periods (April 2009 to March 2014) were included. Evidence of a palliative care approach was identified from primary care records, and death in hospital from secondary care data.

Results From 2009 to 2014, proportions with a primary care record of palliative care increased for COPD from 13.6% to 21.2%; dementia from 20.9% to 40.7%; and heart failure from 12.6% to 21.2%; but remained substantially lower than for cancer (57.6% to 61.9%). Median days before death of recording improved for COPD (145 to 224) and dementia (44 to 209); but not for heart failure (168.5 to 153) and cancer (123 to 114). Trends in hospital deaths were not consistently downward, although the proportions of patients dying in hospital were lower in the last period compared with the first.

Conclusions Recording of a palliative care approach for non-cancer conditions has increased since the introduction of the UK End-of-Life Care Strategy, but remains inadequate.

  • primary health care
  • palliative care
  • neoplasms
  • chronic obstructive pulmonary disease
  • heart failure
  • dementia
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Footnotes

  • Twitter @MJJohnson_HYMS

  • Contributors All authors were responsible for the design and conduct of the study. AG and EK designed and created the database. EK and VA conducted the statistical analyses. AG, EK and VA drafted and revised the paper. SEO, MJJ and UM revised the draft paper. All authors have approved the final version for publication. AG is the guarantor of this study.

  • Funding Academy of Medical Sciences (AMS-SGCL11-Gadoud) and Hull York Medical School.

  • Disclaimer This study was based on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare Products Regulatory Agency. However, the interpretation and conclusions contained in the study are those of the authors alone.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The CPRD Group has obtained ethics approval from a National Research Ethics Service Committee (NRES) for all purely observational research using anonymised CPRD data. This study was approved by the Independent Scientific Advisory Committee (ISAC) for Medicines and Healthcare products Regulatory Agency (MHRA) database research permission (Protocol No: 10_168R). No further ethics approval was required for the analysis of the data.

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

  • Data availability statement No data are available.

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