BACKGROUND: Understanding service provision for patients with advanced disease is a research priority, with a need to identify barriers that limit widespread integration of palliative care. AIM: To identify patient and organisational factors that influence the duration of hospice-based palliative care in the United Kingdom prior to death. DESIGN: This is a retrospective cohort study. SETTING/PARTICIPANTS: A total of 64 UK hospices providing specialist palliative care inpatient beds and community services extracted data for all adult decedents (aged over 17 years) with progressive, advanced disease, with a prior referral (e.g. inpatient, community teams, and outpatient) who died between 1 January 2015 and 31 December 2015. Data were requested for factors relating to both the patient and hospice site. RESULTS: Across 42,758 decedents, the median time from referral to death was 48 days. Significant differences in referral to death days were found for those with cancer (53 days) and non-cancer (27 days) ( p < 0.0001). As age increases, the median days from referral to death decreases: for those under 50 years (78 days), 50-74 years (59 days), and 75 years and over (39 days) ( p = 0.0001). An adjusted multivariable negative binomial model demonstrated increasing age persisting as a significant predictor of fewer days of hospice care, as did being male, having a missing ethnicity classification and having a non-cancer diagnosis ( p < 0.001). CONCLUSION: Despite increasing rhetoric around early referral, patients with advanced disease are receiving referrals to hospice specialist palliative care very late in their illness trajectory. Age and diagnosis persist as determinants of duration of hospice specialist palliative care before death.
BACKGROUND: Understanding service provision for patients with advanced disease is a research priority, with a need to identify barriers that limit widespread integration of palliative care. AIM: To identify patient and organisational factors that influence the duration of hospice-based palliative care in the United Kingdom prior to death. DESIGN: This is a retrospective cohort study. SETTING/PARTICIPANTS: A total of 64 UK hospices providing specialist palliative care inpatient beds and community services extracted data for all adult decedents (aged over 17 years) with progressive, advanced disease, with a prior referral (e.g. inpatient, community teams, and outpatient) who died between 1 January 2015 and 31 December 2015. Data were requested for factors relating to both the patient and hospice site. RESULTS: Across 42,758 decedents, the median time from referral to death was 48 days. Significant differences in referral to death days were found for those with cancer (53 days) and non-cancer (27 days) ( p < 0.0001). As age increases, the median days from referral to death decreases: for those under 50 years (78 days), 50-74 years (59 days), and 75 years and over (39 days) ( p = 0.0001). An adjusted multivariable negative binomial model demonstrated increasing age persisting as a significant predictor of fewer days of hospice care, as did being male, having a missing ethnicity classification and having a non-cancer diagnosis ( p < 0.001). CONCLUSION: Despite increasing rhetoric around early referral, patients with advanced disease are receiving referrals to hospice specialist palliative care very late in their illness trajectory. Age and diagnosis persist as determinants of duration of hospice specialist palliative care before death.
Authors: Gareth Myring; Paul Mark Mitchell; W George Kernohan; Sonja McIlfatrick; Sarah Cudmore; Anne M Finucane; Lisa Graham-Wisener; Alistair Hewison; Louise Jones; Joanne Jordan; Laurie McKibben; Deborah H L Muldrew; Shazia Zafar; Joanna Coast Journal: BMC Palliat Care Date: 2022-07-08 Impact factor: 3.113
Authors: Roni Nitecki; Shuangshuang Fu; Kirsten A Jorgensen; Lauren Gray; Carolyn Lefkowits; Benjamin D Smith; Larissa A Meyer; Alexander Melamed; Sharon H Giordano; Pedro T Ramirez; Jose Alejandro Rauh-Hain Journal: Int J Gynecol Cancer Date: 2021-11-16 Impact factor: 4.661
Authors: Jake Tobin; Alice Rogers; Isaac Winterburn; Sebastian Tullie; Asanish Kalyanasundaram; Isla Kuhn; Stephen Barclay Journal: BMJ Support Palliat Care Date: 2021-02-19 Impact factor: 4.633
Authors: Yousuf ElMokhallalati; Stephen H Bradley; Emma Chapman; Lucy Ziegler; Fliss Em Murtagh; Miriam J Johnson; Michael I Bennett Journal: Palliat Med Date: 2020-06-07 Impact factor: 4.762
Authors: Roberta I Jordan; Matthew J Allsop; Yousuf ElMokhallalati; Catriona E Jackson; Helen L Edwards; Emma J Chapman; Luc Deliens; Michael I Bennett Journal: BMC Med Date: 2020-11-26 Impact factor: 8.775
Authors: Katherine A Ornstein; David L Roth; Jin Huang; Emily B Levitan; J David Rhodes; Chanee D Fabius; Monika M Safford; Orla C Sheehan Journal: JAMA Netw Open Date: 2020-08-03
Authors: Paul Mark Mitchell; Joanna Coast; Gareth Myring; Federico Ricciardi; Victoria Vickerstaff; Louise Jones; Shazia Zafar; Sarah Cudmore; Joanne Jordan; Laurie McKibben; Lisa Graham-Wisener; Anne M Finucane; Alistair Hewison; Erna Haraldsdottir; Kevin Brazil; W George Kernohan Journal: BMC Palliat Care Date: 2020-08-07 Impact factor: 3.234