Article Text
PDF
Abstract
Objectives To evaluate the impact of provision and timing of palliative care (PC) on potentially inappropriate end-of-life care to patients with cancer in a mixed generalist—specialist PC model.
Method A retrospective population-based observational study using a national administrative health insurance database. All 43 067 adults in the Netherlands, who were diagnosed with or treated for cancer during the year preceding their death in 2017, were included. Main exposure was either generalist or specialist PC initiated >30 days before death (n=16 967). Outcomes were measured over the last 30 days of life, using quality indicators for potentially inappropriate end-of-life care.
Results In total, 14 504 patients (34%) experienced potentially inappropriate end-of-life care; 2732 were provided with PC >30 days before death (exposure group) and 11 772 received no PC or ≤30 days before death (non-exposure group) (16% vs 45%, p<0.001). Most patients received generalist PC (88%). Patients provided with PC >30 days before death were 5 times less likely to experience potentially inappropriate end-of-life care (adjusted OR (AOR) 0.20; (95% CI 0.15 to 0.26)) than those with no PC or PC in the last 30 days. Both early (>90 days) and late (>30 and≤90 days) PC initiation had lower odds for potentially inappropriate end-of-life care (AOR 0.23 and 0.19, respectively).
Conclusion Timely access to PC in a mixed generalist—specialist PC model significantly decreases the likelihood of potentially inappropriate end-of-life care for patients with cancer. Generalist PC can play a substantial role.
- end of life care
- cancer
- quality of life
- supportive care
- clinical decisions
Data availability statement
Data are available upon reasonable request. The data set from this study is held securely in coded form at Vektis Business Intelligence Center for Healthcare. While data sharing agreements prohibit Vektis from making data sets publicly available, access may be granted to those who meet prespecified criteria for confidential access. The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the program may rely upon coding templates and macros that are unique to Vektis.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request. The data set from this study is held securely in coded form at Vektis Business Intelligence Center for Healthcare. While data sharing agreements prohibit Vektis from making data sets publicly available, access may be granted to those who meet prespecified criteria for confidential access. The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the program may rely upon coding templates and macros that are unique to Vektis.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors JA had full access to all data and MB, CP, NR and HF had access to most of the data in the study. MB, CP, JA, NR and HF take responsibility as guarantors for the integrity of the data and the accuracy of the data analysis. MB, CP, NR and HF conceived and designed the study. JA collected the data. MB, CP, YL, NR and HF interpreted the data. MB, JA and HF undertook the statistical analysis. MB drafted the manuscript. All authors provided critical input to the analyses, interpreted the data and critically revised the manuscript. YL, KV, NR and HF supervised the study.
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.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.