scholarly journals Knowledge and Beliefs About End-of-Life Care and the Effects of Specialized Palliative Care: A Population-Based Survey in Japan

2006 ◽  
Vol 31 (4) ◽  
pp. 306-316 ◽  
Author(s):  
Tatsuya Morita ◽  
Mitsunori Miyashita ◽  
Makiko Shibagaki ◽  
Kei Hirai ◽  
Tomoko Ashiya ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Population Based ◽  
Life Care ◽  
Knowledge And Beliefs ◽  
Specialized Palliative Care ◽  
Population Based Survey

End-of-life care in cancer and dementia: a nationwide population-based study of palliative care policy changes

2019 ◽  
pp. bmjspcare-2019-001782 ◽  
Author(s):  
Lou-Ching Kuo ◽  
Jung Jae Lee ◽  
Denise Shuk Ting Cheung ◽  
Ping-Jen Chen ◽  
Chia-Chin Lin
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Population Based ◽  
Life Care ◽  
Population Based Study ◽  
Patients With Cancer ◽  
Insurance Programme ◽  
National Health Insurance Programme ◽  
Vasopressor Use

ObjectivesThe National Health Insurance programme started providing coverage for inpatient care in palliative care (PC) units of acute care hospitals in 2000; however, initially, only PC provided to patients with terminal cancer was covered. A PC policy that enabled PC reimbursement for patients with dementia was implemented in 2009. However, the association of this PC policy with end-of-life care remains unclear. The study aims to compare the association of the PC policy with end-of-life care between patients with dementia and patients with cancer during the last 6 months of their lives.MethodsWe analysed the claims data of 7396 patients dying with dementia (PDD) and 24 319 patients dying with cancer (PDC) during 1997–2013.ResultsAmong PDC, while the percentage of receiving PC increased from 3.6% in 1999 to 14.2% by the end of 2000 (adjusted OR (aOR)=4.07, 95% CI 2.70 to 6.13) and from 20.9% in 2010 to 41.0% in 2013 (aOR=1.40, 95% CI 1.33 to 1.47), vasopressor use decreased from 71.6% in 1999 to 35.5% in 2001 (aOR=0.90, 95% CI 0.82 to 0.98). Among PDD, PC use increased from 0.2% in 2009 to 4.9% in 2013 (aOR=2.05, 95% CI 1.60 to 2.63) and cardiopulmonary resuscitation use decreased from 17.6% in 2009 to 10.0% in 2013 (aOR=0.83, 95% CI 0.76 to 0.90).ConclusionsImplementation of the PC policy in Taiwan was associated with improved PC utilisation among patients with cancer and dementia, which may reduce unnecessary medical care procedures.

scholarly journals Inappropriate end-of-life cancer care in a generalist and specialist palliative care model: a nationwide retrospective population-based observational study

2020 ◽  
pp. bmjspcare-2020-002302
Author(s):  
Manon S Boddaert ◽  
Chantal Pereira ◽  
Jeroen Adema ◽  
Kris C P Vissers ◽  
Yvette M van der Linden ◽  
...  
Keyword(s):  
Palliative Care ◽  
Observational Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Population Based ◽  
Exposure Group ◽  
Life Care ◽  
Patients With Cancer ◽  
Timely Access ◽  
The Impact

ObjectivesTo evaluate the impact of provision and timing of palliative care (PC) on potentially inappropriate end-of-life care to patients with cancer in a mixed generalist—specialist PC model.MethodA retrospective population-based observational study using a national administrative health insurance database. All 43 067 adults in the Netherlands, who were diagnosed with or treated for cancer during the year preceding their death in 2017, were included. Main exposure was either generalist or specialist PC initiated >30 days before death (n=16 967). Outcomes were measured over the last 30 days of life, using quality indicators for potentially inappropriate end-of-life care.ResultsIn total, 14 504 patients (34%) experienced potentially inappropriate end-of-life care; 2732 were provided with PC >30 days before death (exposure group) and 11 772 received no PC or ≤30 days before death (non-exposure group) (16% vs 45%, p<0.001). Most patients received generalist PC (88%). Patients provided with PC >30 days before death were 5 times less likely to experience potentially inappropriate end-of-life care (adjusted OR (AOR) 0.20; (95% CI 0.15 to 0.26)) than those with no PC or PC in the last 30 days. Both early (>90 days) and late (>30 and≤90 days) PC initiation had lower odds for potentially inappropriate end-of-life care (AOR 0.23 and 0.19, respectively).ConclusionTimely access to PC in a mixed generalist—specialist PC model significantly decreases the likelihood of potentially inappropriate end-of-life care for patients with cancer. Generalist PC can play a substantial role.

scholarly journals Equal palliative care for foreign-born patients: A national quality register study

2021 ◽  
pp. 1-8
Author(s):  
Maria E. Carlsson ◽  
Katarina Hjelm
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Quality Indicators ◽  
End Of Life Care ◽  
General Pattern ◽  
Life Care ◽  
Foreign Born ◽  
Quality Register ◽  
National Quality ◽  
Specialized Palliative Care

Abstract Objectives To use data from a national quality register to investigate if there are differences relating to migrant background in the quality of end-of-life care of patients dying in Sweden. Methods A retrospective, comparative register-based study. In total, 81,418 deceased patients, over 18 years of age, registered in the Swedish Register of Palliative Care during 2017 and 2018, of expected death were included in the study. Of these, 72,012 were Swedish-born and 9,395 were foreign-born. Descriptive and analytical statistical methods were used. Results No general pattern of differences in quality regarding end-of-life care was found between Swedish- and foreign-born patients. There were several significant differences in various quality indicators but not in a specific direction. Sometimes, the quality indicators showed an advantage for Swedish-born patients but just as often, they were also favorable for foreign-born patients. Swedish-born patients had greater access to specialized palliative care than foreign-born patients. Foreign-born patients were more often cared for in general home care setting, despite a higher frequency of cancer diagnosis. Significance of results Foreign-born patients were less likely to be cared for in specialized palliative care units and had poorer access to palliative care teams than Swedish-born patients, despite having a higher proportion of cancer diagnoses. However, no general pattern was found indicating that foreign-born patients were disadvantaged in the quality indicators measured in the present study. Perhaps, this is an indication that the palliative care in Sweden is individualized; nonetheless, the quality of end-of-life care would be higher if dying patients, regardless of country of birth, have better access to specialized palliative care.

Early referral to a palliative team improves end-of-life care among gynecological cancer patients: a retrospective, population-based study

2022 ◽  
pp. ijgc-2021-002898
Author(s):  
Torbjørn Paulsen ◽  
Heidi Liland ◽  
Tor Åge Myklebust ◽  
Kristina Lindemann
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
Gynecological Cancer ◽  
Population Based ◽  
Life Care ◽  
Early Palliative Care ◽  
Disease Trajectory ◽  
Norwegian Radium Hospital

ObjectiveTo assess end-of-life care among patients with gynecological cancer, and to describe the association between timing of palliative care referral and patterns of care.MethodsAll women with residence in Oslo, Norway, who died of gynecological cancer between January 1, 2015 and December 30, 2017 (36 months), were identified. Patients were primarily treated at the Norwegian Radium Hospital and clinical data on end-of-life care were retrospectively extracted from the medical records.ResultsWe identified 163 patients with median age 70.1 years at death (range 26–100) with the following diagnoses: ovarian (n=100), uterine (n=40), cervical (n=21), and vulvar cancer (n=2). 53 (33%) of patients died in a palliative care unit, 34 patients (21%) died in nursing homes without palliative care, and 48 (29%) patients died in hospital. Only 15 (9%) patients died at home. 25 (15%) patients received chemotherapy in the last 30 days before death, especially ovarian cancer patients (n=21, 21%). 103 patients (61%) were referred to a palliative team prior to death. Referral to a palliative team was associated with a significantly reduced risk of intensive care unit admission (OR 0.11, 95% CI 0.02 to 0.62) and higher likelihood of a structured end-of-life discussion (OR 2.91, 95% CI 1.03 to 8.25). Palliative care referral also seemed to be associated with other quality indicators of end-of-life care (less chemotherapy use, more home deaths).ConclusionsEnd-of-life care in patients with gynecological cancer suffers from underuse of palliative care. Chemotherapy is still commonly used towards end-of-life. Early palliative care referral in the disease trajectory may be an important step towards improved end-of-life care.

scholarly journals Health care Professionals’ Experiences and Needs When Delivering End-of-Life Care to Children: A Qualitative Study

2017 ◽  
Vol 10 ◽  
pp. 117822421772477 ◽  
Author(s):  
Eva Bergsträsser ◽  
Eva Cignacco ◽  
Patricia Luck
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Life Care ◽  
Structural Problems ◽  
Palliative Care Teams ◽  
Specialized Palliative Care ◽  
Eol Care

Pediatric end-of-life care (EOL care) entails challenging tasks for health care professionals (HCPs). Little is known about HCPs’ experiences and needs when providing pediatric EOL care in Switzerland. This study aimed to describe the experiences and needs of HCPs in pediatric EOL care in Switzerland and to develop recommendations for the health ministry. The key aspect in EOL care provision was identified as the capacity to establish a relationship with the dying child and the family. Barriers to this interaction were ethical dilemmas, problems in collaboration with the interprofessional team, and structural problems on the level of organizations. A major need was the expansion of vocational training and support by specialized palliative care teams. We recommend the development of a national concept for the provision of EOL care in children, accompanied by training programs and supported by specialized pediatric palliative care teams located in tertiary children’s hospitals.

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