Access to Palliative Care during a Terminal Hospitalization.

Abstract

<b><i>Background:</i></b> Research shows that access to palliative care can help patients avoid dying in hospital. However, access to palliative care services during the terminal hospitalization, specifically, has not been well studied. <b><i>Objective:</i></b> To determine whether access to palliative care varied by disease trajectory among terminal hospitalizations. <b><i>Design, Setting, Subjects:</i></b> We conducted a population-based retrospective cohort study of decedents who died in hospital in Ontario, Canada between 2012 and 2015 by using linked administrative databases. <b><i>Measurements:</i></b> Using hospital and physician billing codes, we classified access to palliative care in three mutually exclusive groups of patients with terminal hospitalization: (1) main diagnosis for admission was palliative care; (2) main diagnosis was not palliative care, but the patient received palliative care specialist consultation; and (3) the patient did not receive any specialist palliative care. We conducted a logistic regression on odds of never receiving palliative care. <b><i>Results:</i></b> We identified 140,475 decedents who died in an inpatient hospital unit, which represents 42% of deaths. Among inpatient hospital deaths, 23% (<i>n</i> = 32,168) had palliative care listed as the main diagnosis for admission, 41% (<i>n</i> = 58,210) received specialist palliative care consultation, and 36% (<i>n</i> = 50,097) never had access to specialist palliative care. In our regression, dying of organ failure or frailty compared with cancer increased the odds of never receiving palliative care by 4.07 (95% confidence interval [CI]: 3.95-4.20) and 4.51 (95% CI: 4.35-4.68) times, respectively. <b><i>Conclusions:</i></b> A third of hospital deaths had no palliative care involvement. Access to specialist palliative care is particularly lower for noncancer decedents. Inpatient units play an important role in providing end-of-life care.