RT Journal Article
SR Electronic
T1 Impact of comprehensive hospice palliative care on end-of-life care: a propensity-score–matched retrospective observational study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E197
OP E202
DO 10.9778/cmajo.20180148
VO 7
IS 2
A1 Michael S.C. Conlon
A1 Joseph M. Caswell
A1 Andrew Knight
A1 Barbara Ballantyne
A1 Stacey A. Santi
A1 Margaret L. Meigs
A1 Craig C. Earle
A1 Mark Hartman
YR 2019
UL http://www.cmajopen.ca/content/7/2/E197.abstract
AB Background: Access to hospice palliative care may improve quality of life, reduce the use of potentially aggressive end-of-life care and allow for death to occur outside of an acute care hospital. The aim of this study was to examine the impact of an ambulatory hospice palliative care program on end-of-life care compared to care received by a matched control group of deceased patients.Methods: This retrospective study included patients who received hospice palliative care through the Symptom Management Program in Sudbury, Ontario, during 2012–2015. Using linked administrative health records, we defined a propensity-matched control group and derived 4 previously defined variables associated with aggressive end-of-life care (chemotherapy received in the last 2 wk of life, > 1 emergency department visit within 30 d of death, > 1 hospital admission within 30 d of death and at least 1 intensive care unit admission within 30 d of death). We also examined place of death. We measured family/caregiver satisfaction with care 3 months after the patient’s death using the FAMCARE questionnaire.Results: Of 914 eligible decedents enrolled in the Symptom Management Program, 754 (82.5%) were matched. Receiving care through the program was protective for most measures of aggressive end-of-life care (absolute risk reduction [ARR] 12.73, 95% confidence interval [CI] 12.65–12.81 for any end-of-life care outcome) and death in an acute care setting (ARR 19.89, 95% CI 19.78–20.00). Of the 450 family caregivers invited to complete the FAMCARE questionnaire, 190 (42.2%) returned completed surveys; following data linkage and matching, 96 (21.3%) were available for analysis. Satisfaction with care received within the program appeared high (mean total score 85.72/100).Interpretation: Provision of hospice palliative care through this ambulatory program was associated with lower use of aggressive end-of-life care and death outside of an acute care hospital. Improving access could be expected to provide positive benefits at the individual and system level.