Objectives The rapid ageing population of Hong Kong has a high demand on oncology and palliative care (PC) service. This study was the first territory-wide assessment in Hong Kong to assess the palliative service coverage in patients with advanced cancer in the past decade.
Methods Cancer deaths of all 43 public hospitals of Hong Kong were screened. Randomly selected 2800 cancer deaths formed a representative cohort in all seven service clusters of Hospital Authority at 4 time points (2006, 2009, 2012, 2015). Individual patient records were thoroughly reviewed. Predictors of PC coverage was evaluated in univariable and multivariable analyses.
Results From 2006 to 2015, PC coverage improved steadily from 55.4% to 68.9% (p<0.001). Median time of referral to PC service to death was 25 days (IQR: 53). For duration of inpatient PC, the median time was 22 days (IQR: 44) and it was stable over the past 10 years. Median time of referral to outpatient service to death was 74 days (IQR: 144) and there was an improvement observed (p<0.05). The current system was highly heterogeneous that PC varied between 9.8% and 84.8% in different hospitals depending on the PC service infrastructure. Multivariable Cox model identified patients associated with lower PC coverage: male, <50, rapid disease deterioration and staying in hospitals without multidisciplinary team clinic and designated palliative bed support (all p<0.01).
Conclusion There was concrete achievement in palliative service development in the past decade. Heterogeneity and late service provision should be addressed in future.
- end of life care
- hospice care
Data availability statement
No data are available. Not available since national legislation and the terms of study ethics approval do not allow dataset sharing outside of the institutions participating in the analysis.
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SKC and TCL contributed equally.
Contributors SKC, TCL designed study concepts. SKC, TCL, HC-WC developed methodology. All authors performed data acquisition. SKC, TCL, HC-WC performed data analysis and interpretation. Authors drafted the work or revised it critically for important intellectual content; approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This study was supported by all seven service clusters of Hospital Authority.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.