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Specialist palliative cancer care in acute hospitals and place of death: a population study
  1. Maria Kelly1,
  2. Katie M O'Brien1 and
  3. Ailish Hannigan2,3
  1. 1National Cancer Registry, Cork, Ireland
  2. 2School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
  3. 3Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
  1. Correspondence to Ms Maria Kelly, National Cancer Registry, Cork T12 CDF7, Ireland; m.kelly{at}ncri.ie

Abstract

Objective This study compares the characteristics and place of death of patients with cancer receiving specialist palliative care in acute hospitals with those who do not.

Methods All patients with incident invasive cancer in Ireland (1994–2016 inclusive), excluding non-melanoma skin cancer, who attended a cancer centre and died in 2016 were identified from cancer registry data. Patients were categorised based on a diagnosis code ‘Encounter for palliative care’ from linked hospital episode data. Place of death was categorised from death certificate data. Data were analysed using descriptive statistics, χ2 tests and logistic regression.

Results Of n=4103 decedents identified, 62% had a hospital-based palliative care encounter in the year preceding death. Age (p<0.001), marital status (p=0.017), deprivation index (p<0.001) and health board region (p=0.008) were independent predictors of having a palliative care encounter. Place of death differed by palliative care encounter group: 45% of those with an encounter died in hospital versus 50% without an encounter, 33% vs 16% died in a hospice and 18% vs 28% died at home (p<0.001).

Conclusion Almost two-thirds of patients with cancer who attended a cancer centre and died in 2016 had a palliative care encounter. They were younger, less likely to be married and more likely to be from deprived areas. Having accounted for sociodemographic factors, there was evidence of regional variation in receiving care. Demographic and clinical factors and the provision of health services in a region need to be considered together when assessing end-of-life care.

  • cancer
  • terminal care
  • hospital care
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Footnotes

  • Contributors MK and AH conceived and developed the study. MK acquired the data, carried out the analysis and drafted the initial manuscript. KMOB and AH provided statistical support, helped with interpretation of data and results. All authors contributed to manuscript revisions and the final draft. All authors read and approved the final manuscript. MK is the guarantor and responsible for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data availability: National Cancer Registry Ireland has permission under the Health (Provision of Information) Act 1997 to collect and hold data on all persons diagnosed with cancer in Ireland. The use of these data for research is covered by the Statutory Instrument which established the Registry Board in 1991. Data on date and place of death were accessed via the NCRI under an agreement with the Office of the Registrar, Civil Registration Service. The NCRI receives information on hospital discharges (HIPE data) from Health Care Executive Healthcare Pricing Office (HSE HPO). All data sets were deidentified prior to analysis. The NCRI can be contacted as follows: web address: https://www.ncri.ie, by email: data-requests@ncri.ie, by telephone: direct dial: +353 (0) 21 4318014, by fax: +353 (0) 21 4318016, by post: National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork T12 CDF7. The cancer mortality data are collected and held by the General Register Office (GRO). The GRO can be contacted as follows: email address: gro@groireland.ie, by telephone: direct dial: +353(0)90 6632900, LoCall: 1890 252076, by fax: +353(0)90 6632999, by post: General Register Office, Government Offices, Convent Road, Roscommon, Co Roscommon, F42 VX53. The HIPE system is managed by the HPO. The HPO can be contacted as follows: web address: http://www.hpo.ie, by email: info@hpo.ie, by telephone: +353 1 7718417, by fax: +353 1 7718414, by post: Healthcare Pricing Office (HPO), Brunel Building, Heuston South Quarter, St John’s Road West, Dublin 8.

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