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Background To avoid aggressive treatments at the end-of-life (EOL) and to provide palliative care (PC), physicians need to terminate futile anti-cancer treatments and define the palliative intention of the treatment in time, i.e. make the PC decision. This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death.
Methods A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 –Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision and use of PC unit services were examined in relation to emergency department (ED) visits, hospital inpatient days and place of death.
ResultsThe PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients visited the PC unit (>180 days prior to death 72% and <14 days 10%). The number of ED visits and inpatient days were significantly highest for patients with no PC decision and lowest for patients with both a PC decision and a PC unit visit (60 days before death ED visits 1.3 vs 0.8 and inpatient days 9.9 vs 2.9 respectively, p<0.01). Patients with no PC decision died more often in secondary/tertiary hospitals (28% vs. 19% with a PC decision, and 6% with a decision and a visit to a PC unit).
ConclusionsThe PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. The earlier the decision the greater the effect. Contact with a PC unit further increased the likelihood of EOL care at primary care.
Keywords
palliative care, cancer, end-of-life care, hospitalization, emergency department, place of death, advance care planning, Finland
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View the published article at BMC Palliative Care.
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Editorial decision: Accept
On 17 Mar, 2020
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On 16 Mar, 2020
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On 15 Mar, 2020
Editor invited
On 15 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 12 Mar, 2020
Editor assigned
On 06 Mar, 2020
Submission checks complete
On 05 Mar, 2020
Editor invited
On 05 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 26 Feb, 2020
Review #3 received
Received 23 Feb, 2020
Reviewer #3 agreed
On 12 Feb, 2020
Review #2 received
Received 29 Jan, 2020
Reviewers invited
Invitations sent on 29 Jan, 2020
Reviewer #1 agreed
On 29 Jan, 2020
Reviewer #2 agreed
On 29 Jan, 2020
Review #1 received
Received 29 Jan, 2020
Editor assigned
On 27 Jan, 2020
Submission checks complete
On 26 Jan, 2020
Editor invited
On 26 Jan, 2020
Version 1
Posted 25 Nov, 2019
No comments provided
Editorial decision: Minor revision
On 13 Jan, 2020
Review #2 received
Received 06 Jan, 2020
Review #3 received
Received 02 Jan, 2020
Review #1 received
Received 28 Dec, 2019
Reviewer #3 agreed
On 20 Dec, 2019
Reviewer #2 agreed
On 18 Dec, 2019
Reviewer #1 agreed
On 13 Dec, 2019
Reviewers invited
Invitations sent on 10 Dec, 2019
Editor assigned
On 22 Nov, 2019
Submission checks complete
On 21 Nov, 2019
Editor invited
On 19 Nov, 2019
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Subject Areas
Anesthesiology & Pain Medicine
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See the published version of this preprint at BMC Palliative Care.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Palliative Care.
No community comments so far
Editorial decision: Accept
On 17 Mar, 2020
Editor assigned
On 16 Mar, 2020
Submission checks complete
On 15 Mar, 2020
Editor invited
On 15 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 12 Mar, 2020
Editor assigned
On 06 Mar, 2020
Submission checks complete
On 05 Mar, 2020
Editor invited
On 05 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 26 Feb, 2020
Review #3 received
Received 23 Feb, 2020
Reviewer #3 agreed
On 12 Feb, 2020
Review #2 received
Received 29 Jan, 2020
Reviewers invited
Invitations sent on 29 Jan, 2020
Reviewer #1 agreed
On 29 Jan, 2020
Reviewer #2 agreed
On 29 Jan, 2020
Review #1 received
Received 29 Jan, 2020
Editor assigned
On 27 Jan, 2020
Submission checks complete
On 26 Jan, 2020
Editor invited
On 26 Jan, 2020
Version 1
Posted 25 Nov, 2019
No comments provided
Editorial decision: Minor revision
On 13 Jan, 2020
Review #2 received
Received 06 Jan, 2020
Review #3 received
Received 02 Jan, 2020
Review #1 received
Received 28 Dec, 2019
Reviewer #3 agreed
On 20 Dec, 2019
Reviewer #2 agreed
On 18 Dec, 2019
Reviewer #1 agreed
On 13 Dec, 2019
Reviewers invited
Invitations sent on 10 Dec, 2019
Editor assigned
On 22 Nov, 2019
Submission checks complete
On 21 Nov, 2019
Editor invited
On 19 Nov, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Palliative Care.
Background To avoid aggressive treatments at the end-of-life (EOL) and to provide palliative care (PC), physicians need to terminate futile anti-cancer treatments and define the palliative intention of the treatment in time, i.e. make the PC decision. This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death.
Methods A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 –Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision and use of PC unit services were examined in relation to emergency department (ED) visits, hospital inpatient days and place of death.
ResultsThe PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients visited the PC unit (>180 days prior to death 72% and <14 days 10%). The number of ED visits and inpatient days were significantly highest for patients with no PC decision and lowest for patients with both a PC decision and a PC unit visit (60 days before death ED visits 1.3 vs 0.8 and inpatient days 9.9 vs 2.9 respectively, p<0.01). Patients with no PC decision died more often in secondary/tertiary hospitals (28% vs. 19% with a PC decision, and 6% with a decision and a visit to a PC unit).
ConclusionsThe PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. The earlier the decision the greater the effect. Contact with a PC unit further increased the likelihood of EOL care at primary care.
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