scholarly journals Preferred and actual place of death in haematological malignancies: a report from the UK haematological malignancy research network

2020 ◽  
pp. bmjspcare-2019-002097
Author(s):  
Rebecca Sheridan ◽  
Eve Roman ◽  
Alex G Smith ◽  
Andrew Turner ◽  
Anne C Garry ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Haematological Malignancy ◽  
Care Home ◽  
Healthcare Services ◽  
Population Based ◽  
Place Of Death ◽  
Research Network ◽  
Hospital Death ◽  
The Uk ◽  
Proximity To Death

ObjectivesHospital death is comparatively common in people with haematological cancers, but little is known about patient preferences. This study investigated actual and preferred place of death, concurrence between these and characteristics of preferred place discussions.MethodsSet within a population-based haematological malignancy patient cohort, adults (≥18 years) diagnosed 2004–2012 who died 2011–2012 were included (n=963). Data were obtained via routine linkages (date, place and cause of death) and abstraction of hospital records (diagnosis, demographics, preferred place discussions). Logistic regression investigated associations between patient and clinical factors and place of death, and factors associated with the likelihood of having a preferred place discussion.ResultsOf 892 patients (92.6%) alive 2 weeks after diagnosis, 58.0% subsequently died in hospital (home, 20.0%; care home, 11.9%; hospice, 10.2%). A preferred place discussion was documented for 453 patients (50.8%). Discussions were more likely in women (p=0.003), those referred to specialist palliative care (p<0.001), and where cause of death was haematological cancer (p<0.001); and less likely in those living in deprived areas (p=0.005). Patients with a discussion were significantly (p<0.05) less likely to die in hospital. Last recorded preferences were: home (40.6%), hospice (18.1%), hospital (17.7%) and care home (14.1%); two-thirds died in their final preferred place. Multiple discussions occurred for 58.3% of the 453, with preferences varying by proximity to death and participants in the discussion.ConclusionChallenges remain in ensuring that patients are supported to have meaningful end-of-life discussions, with healthcare services that are able to respond to changing decisions over time.

scholarly journals Determinants of hospital death in haematological cancers: findings from a qualitative study

2017 ◽  
Vol 8 (1) ◽  
pp. 78-86 ◽  
Author(s):  
Dorothy McCaughan ◽  
Eve Roman ◽  
Alexandra G Smith ◽  
Anne Garry ◽  
Miriam Johnson ◽  
...  
Keyword(s):  
Haematological Malignancy ◽  
Qualitative Interviews ◽  
Population Based ◽  
Poor Quality ◽  
Research Network ◽  
Hospital Death ◽  
Haematological Malignancies ◽  
Home Death ◽  
Hospital Deaths ◽  
Advance Planning

ObjectivesCurrent UK health policy promotes enabling people to die in a place they choose, which for most is home. Despite this, patients with haematological malignancies (leukaemias, lymphomas and myeloma) are more likely to die in hospital than those with other cancers, and this is often considered a reflection of poor quality end-of-life care. This study aimed to explore the experiences of clinicians and relatives to determine why hospital deaths predominate in these diseases.MethodsThe study was set within the Haematological Malignancy Research Network (HMRN—www.hmrn.org), an ongoing population-based cohort that provides infrastructure for evidence-based research. Qualitative interviews were conducted with clinical staff in haematology, palliative care and general practice (n=45) and relatives of deceased HMRN patients (n=10). Data were analysed for thematic content and coding and classification was inductive. Interpretation involved seeking meaning, salience and connections within the data.ResultsFive themes were identified relating to: the characteristics and trajectory of haematological cancers, a mismatch between the expectations and reality of home death, preference for hospital death, barriers to home/hospice death and suggested changes to practice to support non-hospital death, when preferred.ConclusionsHospital deaths were largely determined by the characteristics of haematological malignancies, which included uncertain trajectories, indistinct transitions and difficulties predicting prognosis and identifying if or when to withdraw treatment. Advance planning (where possible) and better communication between primary and secondary care may facilitate non-hospital death.

scholarly journals Hospitalizations and emergency department visits trends among elderly individuals in proximity to death: a retrospective population-based study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Claudio Barbiellini Amidei ◽  
Silvia Macciò ◽  
Anna Cantarutti ◽  
Francesca Gessoni ◽  
Andrea Bardin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Cause Of Death ◽  
Risk Groups ◽  
Healthcare Services ◽  
Population Based ◽  
Emergency Department Visits ◽  
Change Point Analysis ◽  
Proximity To Death ◽  
Acute Healthcare

AbstractAcute healthcare services are extremely important, particularly during the COVID-19 pandemic, as healthcare demand has rapidly intensified, and resources have become insufficient. Studies on specific prepandemic hospitalization and emergency department visit (EDV) trends in proximity to death are limited. We examined time-trend specificities based on sex, age, and cause of death in the last 2 years of life. Datasets containing all hospitalizations and EDVs of elderly residents in Friuli-Venezia Giulia, Italy (N = 411,812), who died between 2002 and 2014 at ≥ 65 years, have been collected. We performed subgroup change-point analysis of monthly trends in the 2 years preceding death according to sex, age at death (65–74, 75–84, 85–94, and ≥ 95 years), and main cause of death (cancer, cardiovascular, or respiratory disease). The proportion of decedents (N = 142,834) accessing acute healthcare services increased exponentially in proximity to death (hospitalizations = 4.7, EDVs = 3.9 months before death). This was inversely related to age, with changes among the youngest and eldest decedents at 6.6 and 3.5 months for hospitalizations and at 4.6 and 3.3 months for EDVs, respectively. Healthcare use among cancer patients intensified earlier in life (hospitalizations = 6.8, EDVs = 5.8 months before death). Decedents from respiratory diseases were most likely to access hospital-based services during the last month of life. No sex-based differences were found. The greater use of acute healthcare services among younger decedents and cancer patients suggests that policies potentiating primary care support targeting these at-risk groups may reduce pressure on hospital-based services.

scholarly journals Malnutrition in the UK: where does it begin?

2010 ◽  
Vol 69 (4) ◽  
pp. 465-469 ◽  
Author(s):  
C. A. Russell ◽  
M. Elia
Keyword(s):  
High Risk ◽  
Hospital Admissions ◽  
Care Home ◽  
Healthcare Services ◽  
Care Homes ◽  
Sheltered Housing ◽  
Nutrition Screening ◽  
Good Opportunity ◽  
Outpatient Departments ◽  
The Uk

More than 3 million individuals are estimated to be at risk of malnutrition in the UK, of whom about 93% live in the community. BAPEN's Nutrition Screening Week surveys using criteria based on the ‘Malnutrition Universal Screening Tool’ (‘MUST’) revealed that 28% of individuals on admission to hospital and 30–40% of those admitted to care homes in the previous 6 months were malnourished (medium+high risk using ‘MUST’). About three quarters of hospital admissions and about a third of care home admissions came from their own homes with a malnutrition prevalence of 24% in each case. Outpatient studies using ‘MUST’ showed that 16–20% patients were malnourished and these were associated with more hospital admissions and longer length of stay. In sheltered housing, 10–14% of the tenants were found to be malnourished, with an overall estimated absolute prevalence of malnutrition which exceeded that in hospitals. In all cases, the majority of subjects were at high risk of malnutrition. These studies have helped establish the magnitude of the malnutrition problem in the UK and identified the need for integrated strategies between and within care settings. While hospitals provide a good opportunity to identify malnourished patients among more than 10 million patients admitted there annually and the five- to six-fold greater number attending outpatient departments, commissioners and providers of healthcare services should be aware that much of the malnutrition present in the UK originates in the community before admission to hospitals or care homes or attendance at outpatient clinics.

Place of death and associated factors: a population-based study using death certificate data

2019 ◽  
Vol 29 (4) ◽  
pp. 608-615 ◽  
Author(s):  
María José Cabañero-Martínez ◽  
Andreu Nolasco ◽  
Inmaculada Melchor ◽  
Manuel Fernández-Alcántara ◽  
Julio Cabrero-García
Keyword(s):  
Marital Status ◽  
Cause Of Death ◽  
Death Certificate ◽  
Population Based ◽  
Place Of Death ◽  
Population Based Study ◽  
Urbanization Level ◽  
Sociodemographic Variables ◽  
Death Certificate Data ◽  
At Home

Abstract Background Although studies suggest that most people prefer to die at home, not enough is known about place of death patterns by cause of death considering sociodemographic factors. The objective of this study was to determine the place of death in the population and to analyze the sociodemographic variables and causes of death associated with home as the place of death. Methods Cross-sectional population-based study. All death certificate data on the residents in Spain aged 15 or over who died in Spain between 2012 and 2015 were included. We employed multinomial logistic regression to explore the relation between place of death, sociodemographic variables and cause of death classified according to the International Classification of Diseases, 10th revision, and to conditions needing palliative care. Results Over half of all deaths occurred in hospital (57.4%), representing double the frequency of deaths that occurred at home. All the sociodemographic variables (sex, educational level, urbanization level, marital status, age and country of birth) were associated with place of death, although age presented the strongest association. Cause of death was the main predictor with heart disease, neurodegenerative disease, Alzheimer’s disease, dementia and senility accounting for the highest percentages of home deaths. Conclusions Most people die in hospital. Cause of death presented a stronger association with place of death than sociodemographic variables; of these latter, age, urbanization level and marital status were the main predictors. These results will prove useful in planning end-of-life care that is more closely tailored to people’s circumstances and needs.

scholarly journals Cohort Profile: The Haematological Malignancy Research Network (HMRN): a UK population-based patient cohort

2018 ◽  
Vol 47 (3) ◽  
pp. 700-700g ◽  
Author(s):  
Alexandra Smith ◽  
Debra Howell ◽  
Simon Crouch ◽  
Dan Painter ◽  
John Blase ◽  
...  
Keyword(s):  
Haematological Malignancy ◽  
Population Based ◽  
Research Network ◽  
Patient Cohort

scholarly journals Cell‐of‐origin in diffuse large B‐cell lymphoma: findings from theUK's population‐based Haematological Malignancy Research Network

2018 ◽  
Vol 185 (4) ◽  
pp. 781-784 ◽  
Author(s):  
Daniel Painter ◽  
Sharon Barrans ◽  
Stuart Lacy ◽  
Alexandra Smith ◽  
Simon Crouch ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Haematological Malignancy ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Research Network ◽  
Cell Of Origin ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Specialist integrated haematological malignancy diagnostic services: an Activity Based Cost (ABC) analysis of a networked laboratory service model

2015 ◽  
Vol 68 (4) ◽  
pp. 292-300 ◽  
Author(s):  
C Dalley ◽  
H Basarir ◽  
J G Wright ◽  
M Fernando ◽  
D Pearson ◽  
...  
Keyword(s):  
Haematological Malignancy ◽  
Cost Model ◽  
Standard Of Care ◽  
Diagnostic Error ◽  
Population Based ◽  
Polycythaemia Vera ◽  
Activity Based Costing ◽  
Laboratory Service ◽  
Abc Analysis ◽  
The Uk

AimsSpecialist Integrated Haematological Malignancy Diagnostic Services (SIHMDS) were introduced as a standard of care within the UK National Health Service to reduce diagnostic error and improve clinical outcomes. Two broad models of service delivery have become established: ‘co-located’ services operating from a single-site and ‘networked’ services, with geographically separated laboratories linked by common management and information systems. Detailed systematic cost analysis has never been published on any established SIHMDS model.MethodsWe used Activity Based Costing (ABC) to construct a cost model for our regional ‘networked’ SIHMDS covering a two-million population based on activity in 2011.ResultsOverall estimated annual running costs were £1 056 260 per annum (£733 400 excluding consultant costs), with individual running costs for diagnosis, staging, disease monitoring and end of treatment assessment components of £723 138, £55 302, £184 152 and £94 134 per annum, respectively. The cost distribution by department was 28.5% for haematology, 29.5% for histopathology and 42% for genetics laboratories. Costs of the diagnostic pathways varied considerably; pathways for myelodysplastic syndromes and lymphoma were the most expensive and the pathways for essential thrombocythaemia and polycythaemia vera being the least.ConclusionsABC analysis enables estimation of running costs of a SIHMDS model comprised of ‘networked’ laboratories. Similar cost analyses for other SIHMDS models covering varying populations are warranted to optimise quality and cost-effectiveness in delivery of modern haemato-oncology diagnostic services in the UK as well as internationally.

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