Factors associated with not receiving homecare, end-of-life homecare, or early homecare referral among cancer decedents: A population-based cohort study

Abstract Purpose Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death were limited and had inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. Methods This cohort study included adult cancer patients from 2012–2018, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Results Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects utilized life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR]: 0.82; 95% confidence interval [CI]: 0.80–0.84). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.43, 95% CI: 0.41–0.45), endotracheal intubation (AOR = 0.87, 95%CI: 0.85–0.89), and defibrillation (AOR = 0.52, 95%CI: 0.48–0.57). Conclusion EOL discussions correlated with a lower utilization of life-sustaining treatments during the last three months of life among cancer patients. Our study supports the importance of providing these discussions to cancer patients to better align care with preferences during the EOL treatment.

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Is specialized palliative cancer care associated with use of antineoplastic treatment at the end of life? A population-based cohort study

Palliative Medicine ◽

10.1177/0269216318786393 ◽

2018 ◽

Vol 32 (9) ◽

pp. 1509-1517 ◽

Cited By ~ 6

Author(s):

Kirstine Skov Benthien ◽

Mathilde Adsersen ◽

Morten Aagaard Petersen ◽

Eva Soelberg Vadstrup ◽

Per Sjøgren ◽

...

Keyword(s):

Palliative Care ◽

Cohort Study ◽

End Of Life ◽

Female Gender ◽

Population Based ◽

Hospital Units ◽

Hematological Cancers ◽

Specialized Palliative Care ◽

Antineoplastic Treatment ◽

Breast And Prostate Cancer

Background: The use of chemotherapy in the last 14 days of life should be as low as possible. Aim: To study the factors related to the use of chemotherapy in the last 14 days of life and the factors related to concurrent antineoplastic treatment and specialized palliative care. Design: This was a population-based cohort study. The data were collected from the Danish Register of Causes of Death, the Danish National Patient Register, and the Danish Palliative Care Database. Analyses were descriptive and multivariate logistic regression. Setting/participants: Cancer decedents between 2010 and 2013 in the Capital Region of Denmark. Results: During the study period, 17,246 individuals died of cancer and 33% received specialized palliative care. In the last 14 days of life, 4.2% received chemotherapy. Younger patients and patients with hematological cancers were more likely to receive chemotherapy in the last 14 days of life. Receiving specialized palliative care was associated with a lower risk of receiving chemotherapy in the last 14 days of life—odds ratio 0.15 for hospices and 0.53 for palliative hospital units. A total of 8% of the population received concurrent antineoplastic treatment and specialized palliative care. Female gender, younger age, and breast and prostate cancer were significantly associated with this concurrent model. Conclusion: Overall, the incidence of antineoplastic treatment in the last 14 days of life was low compared to other studies. Patients in specialized palliative care had a reduced risk of receiving chemotherapy at the end of life.

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Factors Associated with Community Residence at the End of Life: A Population-Based Study (TH321B)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2018.12.054 ◽

2019 ◽

Vol 57 (2) ◽

pp. 375-376

Author(s):

Melissa Aldridge ◽

Karen McKendrick ◽

Jennifer Reckrey

Keyword(s):

End Of Life ◽

Population Based ◽

Population Based Study ◽

Factors Associated ◽

Community Residence

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Persistent socioeconomic inequalities in location of death and receipt of palliative care: A population-based cohort study

Palliative Medicine ◽

10.1177/0269216320947964 ◽

2020 ◽

Vol 34 (10) ◽

pp. 1393-1401

Author(s):

Luke Mondor ◽

Walter P Wodchis ◽

Peter Tanuseputro

Keyword(s):

Palliative Care ◽

Cohort Study ◽

End Of Life ◽

Terminal Illness ◽

Home Visits ◽

Population Based ◽

Relative Index ◽

Deprived Neighbourhoods ◽

Location Of Death ◽

Index Of Inequality

Background: Providing equitable care to patients in need across the life course is a priority for many healthcare systems. Aim: To estimate socioeconomic inequality trends in the proportions of decedents that died in the community and that received palliative care within 30 days of death (including home visits and specialist/generalist physician encounters). Design: Cohort study based on health administrative data. Socioeconomic position was measured by area-level material deprivation. Inequality gaps were quantified annually and longitudinally using the slope index of inequality (absolute gap) and relative index of inequality (relative gap). Setting/Participants: A total of 729,290 decedents aged ⩾18 years in Ontario, Canada from 2009 to 2016. Results: In 2016, the modelled absolute gap (corresponding 95% confidence interval) between the most- and least-deprived neighbourhoods in community deaths was 4.0% (2.9–5.1%), which was 8.6% (6.2–10.9%) of the overall mean (46.6%). Relative to 2009, these inequalities declined modestly. Inequalities in 2016 were evident for palliative home visits (6.8% (5.8–7.8%) absolute gap, 26.3% (22.5–30.0%) relative gap) and for physician encounters (6.8% (5.7–7.9%) absolute gap, 13.2% (11.0–15.3%) relative gap), and widened from 2009 for physician encounters only on the absolute scale. Inequalities varied considerably across disease trajectories (organ failure, terminal illness, frailty, and sudden death). Conclusion: Key measures of end-of-life care are not achieved equally across socioeconomic groups. These data can be used to inform policy strategies to improve delivery of palliative and end-of-life services.

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The occurrence and timing of delirium in acute care hospitalizations in the last year of life: A population-based retrospective cohort study

Palliative Medicine ◽

10.1177/0269216320929545 ◽

2020 ◽

Vol 34 (8) ◽

pp. 1067-1077

Author(s):

Colleen Webber ◽

Christine L Watt ◽

Shirley H Bush ◽

Peter G Lawlor ◽

Robert Talarico ◽

...

Keyword(s):

Cohort Study ◽

Confidence Interval ◽

Acute Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Prevalence Ratio ◽

Acute Care Hospitals ◽

Population Based ◽

Care Hospital ◽

Factors Associated

Background: Delirium is a distressing neurocognitive disorder that is common among terminally ill individuals, although few studies have described its occurrence in the acute care setting among this population. Aim: To describe the prevalence of delirium in patients admitted to acute care hospitals in Ontario, Canada, in their last year of life and identify factors associated with delirium. Design: Population-based retrospective cohort study using linked health administrative data. Delirium was identified through diagnosis codes on hospitalization records. Setting/participants: Ontario decedents (1 January 2014 to 31 December 2016) admitted to an acute care hospital in their last year of life, excluding individuals age of <18 years or >105 years at admission, those not eligible for the provincial health insurance plan between their hospitalization and death dates, and non-Ontario residents. Results: Delirium was recorded as a diagnosis in 8.2% of hospitalizations. The frequency of delirium-related hospitalizations increased as death approached. Delirium prevalence was higher in patients with dementia (prevalence ratio: 1.43; 95% confidence interval: 1.36–1.50), frailty (prevalence ratio: 1.67; 95% confidence interval: 1.56–1.80), or organ failure–related cause of death (prevalence ratio: 1.23; 95% confidence interval: 1.16–1.31) and an opioid prescription (prevalence ratio: 1.17; 95% confidence interval: 1.12–1.21). Prevalence also varied by age, sex, chronic conditions, antipsychotic use, receipt of long-term care or home care, and hospitalization characteristics. Conclusion: This study described the occurrence and timing of delirium in acute care hospitals in the last year of life and identified factors associated with delirium. These findings can be used to support delirium prevention and early detection in the hospital setting.

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Opioid prescriptions in patients with osteoarthritis: a population-based cohort study

Rheumatology ◽

10.1093/rheumatology/kez646 ◽

2020 ◽

Vol 59 (9) ◽

pp. 2462-2470 ◽

Cited By ~ 2

Author(s):

Jacoline J van den Driest ◽

Dieuwke Schiphof ◽

Marcel de Wilde ◽

Patrick J E Bindels ◽

Johan van der Lei ◽

...

Keyword(s):

Cohort Study ◽

Patient Characteristics ◽

Population Based ◽

Prescription Rate ◽

Factors Associated ◽

Prescription Rates ◽

Care Information ◽

Information Database

Abstract Objectives To examine the incidence, prevalence and trends for opioid prescriptions in patients with OA. Furthermore, types of opioids prescribed and long-term prescription rates were examined. Finally, the patient characteristics associated with the prescription of opioids were assessed. Methods A population-based cohort study was conducted using the Integrated Primary Care Information database. Incidence and prevalence of opioid prescriptions were calculated for the period 2008–2017. Logistic regression was used to assess which patient characteristics were associated with opioid prescriptions. Results In total, 157 904 OA patients were included. The overall prescription rate remained fairly stable, at around 100 incident and 170 prevalent prescriptions per 1000 person years. However, the incident prescription rate for oxycodone increased from 7.1 to 40.7 per 1000 person years and for fentanyl from 4.2 to 7.4 per 1000 person years. The incident prescription rate for paracetamol/codeine decreased from 63.0 to 13.3 per 1000 person years. Per follow-up year, long-term use was found in 3% of the patients with incident OA. Finally, factors associated with more prescriptions were increasing age, OA in ≥2 joint groups [odds ratio (OR) 1.56; 95% CI: 1.51, 1.65] and the presence of other musculoskeletal disorders (OR 4.91; 95% CI: 4.76, 5.05). Men were less likely to be prescribed opioids (OR 0.78; 95% CI: 0.76, 0.80). Conclusion Prescription rates for opioids remained stable, but types of opioids prescribed changed. Oxycodone and fentanyl were increasingly prescribed, while prescriptions of paracetamol/codeine decreased. Since the benefit of opioids for OA pain is questionable and side effects are common, opioids should be prescribed with caution.

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