Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

Abstract Background End of life(EoL) care becomes more complex and increasingly takes place in the community, but there is little data on the use of general practice(GP) services to guide care improvement. This study aims to determine the trends and factors associated with GP consultation, prescribing and referral to other care services amongst cancer patients in the last year of life. Methods A retrospective cohort study of cancer patients who died in 2000-2014, based on routinely collected primary care data(the Clinical Practice Research DataLink, CPRD) covering a representative sample of the population in the United Kingdom. Outcome variables were number of GP consultations(primary), number of prescriptions and referral to other care services(yes vs no) in the last year of life. Explanatory variables included socio-demographics, clinical characteristics and the status of palliative care needs recognised or not. The association between outcome and explanatory variables were evaluated using multiple-adjusted risk ratio(aRR). Results Of 68,523 terminal cancer patients, 70% were aged 70+, 75% had comorbidities and 45.5% had palliative care needs recognised. In the last year of life, a typical cancer patient had 43 GP consultations(Standard deviation(SD): 31.7; total=3,031,734), 71.5 prescriptions(SD: 68.0; total=5,074,178), and 21(SD: 13.0) different drugs; 58.0% of patients had at least one referral covering all main clinical specialities. More comorbid conditions, prostate cancer and having palliative care needs recognised were associated with more primary care consultations, more prescriptions and a higher chance of referral(aRRs 1.07-2.03). Increasing age was related to fewer consultations(aRRs 0.77-0.96), less prescriptions(aRR 1.09-1.44), and a higher chance of referral(aRRs 1.08-1.16) but less likely to have palliative care needs recognised(aRRs 0.53-0.89). Conclusions GPs are very involved in end of life care of cancer patients, most of whom having complex care needs, i.e. older age, comorbidity and polypharmacy. This highlights the importance of enhancing primary palliative care skills among GPs and the imperative of greater integration of primary care with other healthcare professionals including oncologists, palliative care specialists, geriatricians and pharmacists. Research into the potential of deprescribing is warranted. Older patients have poorer access to both primary care and palliative care need to be addressed in future practices.

Primary care service use by end-of-life cancer patients: a nationwide retrospective cohort study in the United Kingdom

10.21203/rs.2.14885/v1 ◽

2019 ◽

Author(s):

Wei Gao ◽

Martin Gulliford ◽

Myfanwy Morgan ◽

Irene J Higginson

Keyword(s):

Primary Care ◽

Palliative Care ◽

Cohort Study ◽

End Of Life ◽

Cancer Patients ◽

Care Needs ◽

Explanatory Variables ◽

Care Services ◽

The United Kingdom ◽

Abstract Background End of life(EoL) care becomes more complex and increasingly takes place in the community but there is little data on the use of general practice (GP) services to guide care improvement. This study aims to determine the trends and factors associated with GP consultation, prescribing and referral to other care services amongst cancer patients in the last year of life.Methods A nationwide, retrospective cohort study using the Clinical Practice Research DataLink(CPRD) in the United Kingdom primary care, 2001-2014. Outcome variables were number of GP consultations(primary), number of prescriptions and referral to other care services (yes vs no) in the last year of life. Explanatory variables included socio-demographics, clinical characteristics and the status of palliative care needs recognised or not. The association between outcome and explanatory variables were evaluated using multiply adjusted risk ratio(aRR).Results Of 68,523 terminal cancer patients, 70% were aged 70+, 75% had comorbidities and 45.5% had palliative care needs recognised. In the last year of life, a typical cancer patient had 43 GP consultations (Standard deviation(SD): 31.7; total=3,031,734), 71.5 prescriptions (SD: 68.0; total=5,074,178), and 21 (SD: 13.0) different drugs; 58% of patients had at least one referral covering all main clinical specialities. More comorbid conditions, prostate cancer and having palliative care needs recognised were associated with more primary care consultations, more prescriptions and a higher chance of referral (aRRs 1.07-2.03). Increasing age was related to fewer consultations (aRRs: 0.77-0.96), less prescriptions(aRR 1.09-1.44), and a higher chance of referral (aRRs 1.08-1.16) but less likely to have palliative care needs recognised(aRRs 0.53-0.89).Conclusions GPs are very involved in the end of life care of cancer patients, most of whom having complex care needs, i.e. older age, comorbidity and polypharmacy. This highlights the importance of enhancing primary palliative care skills among GPs and the imperative of a greater integration of primary care with other healthcare professionals including oncologists, palliative care specialists, geriatricians and pharmacists. Research into the potential of deprescribing is warranted. Older patients have poorer access to both primary care and palliative care need to be addressed in future practices.

Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

BMC Family Practice ◽

10.1186/s12875-020-01127-8 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Wei Gao ◽

Martin Gulliford ◽

Myfanwy Morgan ◽

Irene J. Higginson

Keyword(s):

Primary Care ◽

Cohort Study ◽

United Kingdom ◽

End Of Life ◽

Cancer Patients ◽

Service Use ◽

Care Service ◽

Population Based ◽

Primary Care Service ◽

The United Kingdom

Identification of palliative care needs among people with dementia and its association with acute hospital care and community service use at the end-of-life: A retrospective cohort study using linked primary, community and secondary care data

Palliative Medicine ◽

10.1177/02692163211019897 ◽

2021 ◽

pp. 026921632110198

Author(s):

Javiera Leniz ◽

Irene J Higginson ◽

Deokhee Yi ◽

Zia Ul-Haq ◽

Amanda Lucas ◽

...

Keyword(s):

Primary Care ◽

Palliative Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hospital Admissions ◽

Care Practice ◽

Care Needs ◽

People With Dementia ◽

Background: Hospital admissions among people dying with dementia are common. It is not known whether identification of palliative care needs could help prevent unnecessary admissions. Aim: To examine the proportion of people with dementia identified as having palliative care needs in their last year of life, and the association between identification of needs and primary, community and hospital services in the last 90 days. Design: Retrospective cohort study using Discover, an administrative and clinical dataset from 365 primary care practices in London with deterministic individual-level data linkage to community and hospital records. Setting/participants: People diagnosed with dementia and registered with a general practitioner in North West London (UK) who died between 2016 and 2019. The primary outcome was multiple non-elective hospital admissions in the last 90 days of life. Secondary outcomes included contacts with primary and community care providers. We examined the association between identification of palliative care needs with outcomes. Results: Among 5804 decedents with dementia, 1953 (33.6%) were identified as having palliative care needs, including 1141 (19.7%) identified before the last 90 days of life. Identification of palliative care needs before the last 90 days was associated with a lower risk of multiple hospital admissions (Relative Risk 0.70, 95% CI 0.58–0.85) and more contacts with the primary care practice, community nurses and palliative care teams in the last 90 days. Conclusions: Further investigation of the mechanisms underlying the association between identification of palliative care needs and reduced hospital admissions could help reduce reliance on acute care for this population.

Palliative care needs of advanced cancer patients in the emergency department at the end of life: an observational cohort study

Supportive Care in Cancer ◽

10.1007/s00520-019-04906-x ◽

2019 ◽

Vol 28 (3) ◽

pp. 1097-1107 ◽

Cited By ~ 4

Author(s):

Mary-Joanne Verhoef ◽

Ellen de Nijs ◽

Nanda Horeweg ◽

Jaap Fogteloo ◽

Christian Heringhaus ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Cohort Study ◽

Cancer Patients ◽

Advanced Cancer ◽

Observational Cohort Study ◽

Care Needs ◽

Observational Cohort ◽

Palliative Referrals in Advanced Cancer Patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211017873 ◽

2021 ◽

pp. 104990912110178

Author(s):

Abigail Sy Chan ◽

Amit Rout ◽

Christopher R. D.’Adamo ◽

Irina Lev ◽

Amy Yu ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Length Of Hospital Stay ◽

Inpatient Setting ◽

Care Needs ◽

Early Palliative Care ◽

Code Status ◽

Background: Timely identification of palliative care needs can reduce hospitalizations and improve quality of life. The Supportive & Palliative Care Indicators Tool (SPICT) identifies patients with advanced medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting. SPICT and RI among cancer patients were utilized in this study to evaluate their potential roles in palliative care referrals. Methods: Advanced cancer patients admitted to an institution in Baltimore, Maryland in 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), palliative care referrals, RI scores, and SPICT scores were obtained. Patients were divided into SPICT positive or negative and RI > 60 or RI < 60.Unpaired t-tests and chi-square tests were utilized to determine the associations between SPICT and RI and early palliative care needs and mortality. Results: 227 patients were included, with a mean age of 68 years, 63% Black, 59% female, with the majority having lung and GI malignancies. Sixty percent were SPICT +, 21% had RI < 60. SPICT + patients were more likely to have RI < 60 (p = 0.001). SPICT + and RI < 60 patients were more likely to have longer LOS, change in code status, more palliative/hospice referrals, and increased mortality (p <0.05). Conclusions: SPICT and RI are valuable tools in predicting mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer.

Palliative Care Needs of Advanced Cancer Patients in the Emergency Department (S767)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2017.12.421 ◽

2018 ◽

Vol 55 (2) ◽

pp. 693

Author(s):

Isabelle Marcelin ◽

Caroline McNaughton ◽

Nicole Tang ◽

Jeffrey Caterino ◽

Corita Grudzen

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Care Needs ◽

‘They patiently heard what we had to say…this felt different to me’: the palliative care needs and care experiences of advanced cancer patients and their families in Bangladesh

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2011-000143 ◽

2012 ◽

Vol 2 (2) ◽

pp. 145-149 ◽

Cited By ~ 6

Author(s):

Rogieh Dehghan ◽

Jairam Ramakrishnan ◽

Nezzan Uddin-Ahmed ◽

Richard Harding

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Care Needs ◽

Identifying Palliative Care Needs in Assisted Living

Innovation in Aging ◽

10.1093/geroni/igaa057.2854 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 788-788

Author(s):

Daniel David ◽

Abraham Brody ◽

Tina Sadarangani ◽

Bei Wu ◽

Tara Cortez

Keyword(s):

Palliative Care ◽

Assisted Living ◽

Unmet Needs ◽

Care Needs ◽

Code Status ◽

Care Services ◽

Palliative Care Services ◽

Advance Care ◽

Abstract Many residents of Assisted Living (AL) confront serious illness and therefore might benefit from greater access to Palliative Care Services to improve quality of life. We surveyed resident records and AL nursing staff to identify patients in need of Palliative Care. Preliminary findings showed that nurses predicted 23% would not be alive and 49% would no longer live in AL. A majority of residents were over the age of 90, yet 30% did not have a reported code status. These findings suggest that a substantial portion of AL residents may have unmet needs with respect to palliative care. Future interventions are needed to support advance care planning conversations and make palliative care more accessible to this population.

Disparities in access to palliative care facilities for patients with and without cancer: A retrospective review

Palliative Medicine ◽

10.1177/02692163211007387 ◽

2021 ◽

pp. 026921632110073

Author(s):

Christine Lau ◽

Christopher Meaney ◽

Matthew Morgan ◽

Rose Cook ◽

Camilla Zimmermann ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Cancer Patients ◽

Performance Status ◽

Retrospective Chart Review ◽

Care Needs ◽

Care Facilities ◽

Palliative Care Services ◽

Low Performance ◽

Electronic Referral

Background: To date, little is known about the characteristics of patients who are admitted to a palliative care bed for end-of-life care. Previous data suggest that there are disparities in access to palliative care services based on age, sex, diagnosis, and socioeconomic status, but it is unclear whether these differences impact access to a palliative care bed. Aim: To better identify patient factors associated with the likelihood/rate of admission to a palliative care bed. Design: A retrospective chart review of all initiated palliative care bed applications through an electronic referral program was conducted over a 24-month period. Setting/participants: Patients who apply and are admitted to a palliative care bed in a Canadian metropolitan city. Results: A total of 2743 patients made a total of 5202 bed applications to 9 hospice/palliative care units in 2015–2016. Referred and admitted cancer patients were younger, male, and more functional than compared to non-cancer patients (all p < 0.001). Referred and admitted patients without cancer were more advanced in their illness trajectory, with an anticipated prognosis <1 month and Palliative Performance Status of 10%–20% (all p < 0.001). On multivariate analysis, a diagnosis of cancer and a prognosis of <3 months were associated with increased likelihood and/or rate of admission to a bed, whereas the presence of care needs, a longer prognosis and a PPS of 30%–40% were associated with decreased rates and/or likelihood of admission. Conclusion: Patients without cancer have reduced access to palliative care facilities at end-of-life compared to patients with cancer; at the time of their application and admission, they are “sicker” with very low performance status and poorer prognoses. Further studies investigating disease-specific clinical variables and support requirements may provide more insights into these observed disparities.