The Impact of Socioeconomic Status on Place of Death Among Patients Receiving Home Palliative Care in Toronto, Canada: A Retrospective Cohort Study

Background: Socioeconomic disparities in home death have been noted in the literature. Home-based palliative care increases access to home death and has been suggested as a means to decrease these disparities. Aim: Our study examines the association between socioeconomic status and other demographic factors on place of death in a population receiving home palliative care in Toronto, Canada. Design: This is a retrospective chart review of patients who died between August 2013 and August 2015 when admitted to a home-based palliative care service. Multivariate multinomial regression examined the relationship between the place of death (home, palliative care unit [PCU], or acute care) with age, gender, primary diagnosis, and income quintile. Bivariate logistic regression was fitted to calculate the odds ratio (OR) and probability of preference for home death. Setting/Participants: Patients receiving home-based palliative care services from the Latner Centre for Palliative Care in Toronto, Canada. Results: A total of 2066 patients were included in multivariate analysis. Patients in the lowest income quintile had increased odds of dying in acute care (OR = 2.41, P < .001) or dying in PCU (OR = 1.64, P = .008) than patients in highest income quintile. Patients in the next lowest income quintiles 2 and 3 were also more likely to die in acute care. The rate of preference for home death was significantly lower in the lowest income quintile (OR = 0.47, P = .0047). Conclusions: Patients in lower income quintiles are less likely to die at home, despite receiving home-based palliative care, although they may also be less likely to prefer home death.

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Factors that Promote Success in Home Palliative Care: A Study of a Large Suburban Palliative Care Practice

Journal of Palliative Care ◽

10.1177/082585970201800406 ◽

2002 ◽

Vol 18 (4) ◽

pp. 282-286 ◽

Cited By ~ 19

Author(s):

Vincent Maida

Keyword(s):

Palliative Care ◽

Home Ownership ◽

Care Service ◽

Palliative Care Service ◽

Care Physician ◽

Care Practice ◽

Evaluation Tool ◽

Home Death ◽

Home Based ◽

At Home

It has been repeatedly shown that most people would prefer to die in their own homes. However, many factors affect the feasibility of this choice. This study retrospectively examined the medical and nursing charts of 402 cancer patients who wished to die at home and had been referred to a palliative care service. Of those reviewed, 223 (55%) died at home, while 179 died in hospitals. The presence of more than one caregiver, an increased length of time between diagnosis and referral to a palliative care physician, an increased length of time under that physician's care, older age at referral, home ownership, and race were all significantly associated with home death, as were certain cancer diagnoses. The most compelling of these predictive factors have formed the basis for an evaluation tool, soon to be validated, to help palliative health professionals assess the viability of home-based palliative care culminating in a home death.

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O-22 The impact of a new children’s palliative care service on place of death: giving families choices

10.1136/spcare-2021-hospice.21 ◽

2021 ◽

Author(s):

Joanna Elverson ◽

Helen Aspey ◽

Owen Lever ◽

Ellie Bond ◽

Christine Mackerness ◽

...

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Place Of Death ◽

The Impact

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Healthcare professionals’ perspectives of patient and family preferences of patient place of death: a qualitative study

BMC Palliative Care ◽

10.1186/s12904-021-00842-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Manjusha K. Sathiananthan ◽

Gregory B. Crawford ◽

Jaklin Eliott

Keyword(s):

Palliative Care ◽

Healthcare Professionals ◽

Care Service ◽

Palliative Care Service ◽

Public Hospitals ◽

Place Of Death ◽

Hospital Death ◽

Home Death ◽

Service Staff ◽

The Ideal

Abstract Background Home death is one of the key performance indicators of the quality of palliative care service delivery. Such a measure has direct implications on everyone involved at the end of life of a dying patient, including a patient’s carers and healthcare professionals. There are no studies that focus on the views of the team of integrated inpatient and community palliative care service staff on the issue of preference of place of death of their patients. This study addresses that gap. Methods Thirty-eight participants from five disciplines in two South Australian (SA) public hospitals working within a multidisciplinary inpatient and community integrated specialist palliative care service, participated in audio-recorded focus groups and one-on-one interviews. Data were transcribed and thematically analysed. Results Two major and five minor themes were identified. The first theme focused on the role of healthcare professionals in decisions regarding place of death, and consisted of two minor themes, that healthcare professionals act to: a) mediate conversations between patient and carer; and b) adjust expectations and facilitate informed choice. The second theme, healthcare professionals’ perspectives on the preference of place of death, comprised three minor themes, identifying: a) the characteristics of the preferred place of death; b) home as a romanticised place of death; and c) the implications of idealising home death. Conclusion Healthcare professionals support and actively influence the decision-making of patients and family regarding preference of place of death whilst acting to protect the relationship between the patient and their family/carer. Further, according to healthcare professionals, home is neither always the most preferred nor the ideal place for death. Therefore, branding home death as the ideal and hospital death as a failure sets up families/carers to feel guilty if a home death is not achieved and undermines the need for and appropriateness of death in institutionalised settings.

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What are the Challenges for Evaluating a Palliative Care Service?

Australian Journal of Primary Health ◽

10.1071/py05038 ◽

2005 ◽

Vol 11 (3) ◽

pp. 19

Author(s):

Kate Senior ◽

David Perkins

Keyword(s):

Palliative Care ◽

Care Service ◽

Medical Model ◽

Palliative Care Service ◽

Respondent Burden ◽

Evaluation Approaches ◽

The Impact

This paper identifies the challenges in researching the impact of a rural palliative care service on its patients, carers and providers in the context of the National Palliative Care Strategy. It describes the use of an anthropological method to overcome problems of acceptability and respondent burden and to enable the elaboration of meaning and valuation by participants. It uses the Griffith Area Palliative Care Service as a case study to illustrate the problems of such research and the value of the anthropological method over more conventional research and evaluation approaches. It makes recommendations about how to assess the outcomes of services such as palliative care where the focus of care is complex, individual and family, and the outcomes go far beyond what can be measured with the medical model.

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P-261 Assessing the impact of interventions to promote clinical effectiveness in a palliative care service

10.1136/bmjspcare-2018-hospiceabs.286 ◽

2018 ◽

Author(s):

Nicola Loveday ◽

Matthew Curtis

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Clinical Effectiveness ◽

The Impact

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Building a Transdisciplinary Approach to Palliative Care in an Acute Care Setting

OMEGA - Journal of Death and Dying ◽

10.2190/om.67.1-2.e ◽

2013 ◽

Vol 67 (1-2) ◽

pp. 43-51 ◽

Cited By ~ 11

Author(s):

Donnelle Daly ◽

Stephen Chavez Matzel

Keyword(s):

Palliative Care ◽

End Of Life ◽

Acute Care ◽

Care Setting ◽

Care Service ◽

Palliative Care Service ◽

Assessment Tools ◽

Community Resources ◽

Acute Care Setting ◽

Transdisciplinary Approach

A transdisciplinary team is an essential component of palliative and end-of-life care. This article will demonstrate how to develop a transdisciplinary approach to palliative care, incorporating nursing, social work, spiritual care, and pharmacy in an acute care setting. Objectives included: identifying transdisciplinary roles contributing to care in the acute care setting; defining the palliative care model and mission; identifying patient/ family and institutional needs; and developing palliative care tools. Methods included a needs assessment and the development of assessment tools, an education program, community resources, and a patient satisfaction survey. After 1 year of implementation, the transdisciplinary palliative care team consisted of seven palliative care physicians, two social workers, two chaplains, a pharmacist, and End-of-Life Nursing Consortium (ELNEC) trained nurses. Palomar Health now has a palliative care service with a consistent process for transdisciplinary communication and intervention for adult critical care patients with advanced, chronic illness.

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The impact of a palliative care service on overall hospital mortality in a comprehensive cancer center

Journal of Clinical Oncology ◽

10.1200/jco.2004.22.90140.8034 ◽

2004 ◽

Vol 22 (14_suppl) ◽

pp. 8034-8034

Author(s):

A. F. Elsayem ◽

R. Jenkins ◽

L. Parmley ◽

M. L. Smith ◽

J. L. Palmer ◽

...

Keyword(s):

Palliative Care ◽

Hospital Mortality ◽

Care Service ◽

Palliative Care Service ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

The Impact

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Adaptations to palliative home care in India in a COVID pandemic: An experiential narrative

Indian Journal of Medical Sciences ◽

10.25259/ijms_13_2021 ◽

2021 ◽

Vol 73 ◽

pp. 48-51

Author(s):

Sunil Rameshchandra Dhiliwal ◽

Ashish Gulia ◽

Naveen Salins

Keyword(s):

Palliative Care ◽

Service Delivery ◽

Care Service ◽

Palliative Care Service ◽

Personal Protection ◽

Care Needs ◽

Personal Protection Equipment ◽

Complex Needs ◽

Care Access ◽

Home Based

India is in the midst of a fierce pandemic with a rapid surge of cases and the health-care system in a quandary. Care of patients with life-limiting illness needing palliative care has been compromised due to limitations in palliative care access and a paradigm shift in the hospital toward care of COVID. Therefore, it is imperative to augment the home-based services so that patients continue to remain at home with their care needs met so that their access to hospitals is restricted for acute and complex needs. To overcome practical aspects of home-based care service delivery, several adaptations were needed. An urban standalone home-based palliative care service provider made adaptations to personal protection, personal protection equipment, and team self-care that facilitated an effective service delivery and satisfaction.

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