Inpatient palliative care: a nationwide analysis.

OBJECTIVE: The implementation of palliative care (PC) is an important challenge for health policy makers. The primary aim of this study was to analyze the effects of inpatient PC for cancer patients in the last six months of life.
METHODS: Based on routine data of a nationwide sickness fund, a retrospective matched-pair analysis was performed to assess the care of cancer patients who were treated at least once on an inpatient PC unit and compare the results to cancer patients who where not treated on an inpatient PC unit. The main categories that were assessed included place of death, cost of health care and surrogates for quality of symptom control, aggressiveness of care, and end of life decisions.
RESULTS: Of 11,355 patients, 841 received PC. Compared with other patients they were more likely to receive opioids (66.8% vs. 55.3%; p<0.0001) and chemotherapy in an outpatient setting (25.5% vs. 19.9%; p=0.004). Provision of artificial nutrition and surgery was similar in both groups. Total costs were higher for PC patients compared to routine care (21,879€ (±14,351€) vs. 17,885€ (±14,326€); difference 3994€ (95%-CI: [2648€; 18,973€]; p<0.0001) and PC patients were more likely to die in hospital (69.9% vs. 55.3%; p<0.0001).
CONCLUSION: Cancer patients treated on a PC inpatient unit where more likely to receive opioids (a surrogate for quality of end-of-life care) but where less likely to die at home and the cost of care for these patients was higher. The results can be interpreted both from (i) a methodological standpoint that assumes confounding due to the fact that the PC patients might have been suffering from more complex symptoms and (ii) a health policy view. For the latter it is important to recognize that the whole potential of PC can only be achieved if PC (a) is provided as a cross-sectoral network, (b) is integrated early in the disease (c) assures specialized PC expertise.