Palliative Medicine http://pmj.sagepub.com/
Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: A retrospective cohort study Mirko Riolfi, Alessandra Buja, Chiara Zanardo, Chiara Francesca Marangon, Pietro Manno and Vincenzo Baldo Palliat Med 2014 28: 403 originally published online 23 December 2013 DOI: 10.1177/0269216313517283 The online version of this article can be found at: http://pmj.sagepub.com/content/28/5/403
Published by: http://www.sagepublications.com
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517283 research-article2013
PMJ0010.1177/0269216313517283Palliative MedicineRiolfi et al.
Original Article
Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: A retrospective cohort study
Palliative Medicine 2014, Vol. 28(5) 403–411 © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269216313517283 pmj.sagepub.com
Mirko Riolfi1, Alessandra Buja2, Chiara Zanardo2, Chiara Francesca Marangon1, Pietro Manno1 and Vincenzo Baldo2
Abstract Background: It has been demonstrated that most patients in the terminal stages of cancer would benefit from palliative home-care services. Aim: The aim of this study was to assess the effectiveness of appropriate palliative home-care services in reducing hospital admissions, and to identify factors predicting the likelihood of patients treated at home being hospitalized. Design: Retrospective cohort study. Setting/participants: We enrolled all 402 patients listed by the Local Health Authority No. 5, Veneto Region (NorthEast Italy), as dying of cancer in 2011. Results: Of the cohort considered, 39.9% patients had been taken into care by a palliative home-care team. Irrespective of age, gender, and type of tumor, patients taken into care by the palliative home-care team were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life. Among the patients taken into care by the palliative home-care team, those with hematological cancers and hepatocellular carcinoma were more likely to be hospitalized, and certain symptoms (such as dyspnea and delirium) were predictive of hospitalization. Conclusions: Our study confirms the effectiveness of palliative home care in enabling patients to spend the final period of their lives at home. The services of a palliative home-care team reduced the consumption of hospital resources. This study also provided evidence of some types of cancer (e.g. hematological cancers and hepatocellular carcinoma) being more likely to require hospitalization, suggesting the need to reconsider the pathways of care for these diseases. Keywords Health services research, home-care service, epidemiology, palliative medicine, comparative effectiveness research
1Palliative
Care Team, Distretto Socio Sanitario Azienda ULSS 5 Ovest Vicentino, Arzignano, Italy 2Department of Molecular Medicine, Laboratory of Public Health and Population Studies, Institute of Hygiene, University of Padova, Padova, Italy
Corresponding author: Alessandra Buja, Department of Molecular Medicine, Laboratory of Public Health and Population Studies, Institute of Hygiene, University of Padova, Via Loredan, 18, 35128 Padova, Italy. Email: [email protected]
Downloaded from pmj.sagepub.com at GEORGE MASON UNIV on July 1, 2014
404
Palliative Medicine 28(5)
What is already known about the topic?
•• The World Health Organization (WHO) recommends that all countries adopt a national palliative care policy for providing home-based care. •• The majority of terminally ill patients would prefer to stay and die at home. •• Providing palliative care at home enables patients to spend the final period of their lives in their own homes. What this paper adds?
•• This study confirmed that terminally ill cancer patients, who were recruited and consent to being cared for by a palliative home-care team (PHCT) at home, are more likely to die at home, and to have fewer hospitalizations and shorter hospital stays in the last 2 months of their lives. •• The study found that patients in the care of a PHCT who had certain types of neoplastic disease, for example, hematological cancers and hepatocellular carcinoma, were more likely to be hospitalized. •• The study indicated that certain symptoms, for example, dyspnea, pain, and delirium, were predictive of patients in the care of a PHCT being hospitalized. Implications for practice, theory, or policy
•• The services of a PHCT might reduce the consumption of hospital resources. •• This study revealed the need to reconsider the pathways of care for hematological cancers and hepatocellular carcinoma in terminally ill patients.
Background Nowadays, cancer has become one of the leading causes of death worldwide. Franks et al.1 estimated that 25% of people in the terminal phase of cancer in the United Kingdom will require inpatient palliative care, and 65% will benefit from home-based palliative care. The World Health Organization (WHO) recommends that all countries adopt a national palliative care policy as a human right, providing different resources and settings, including home-based care.2 Providing palliative care at home preserves the dignity of terminally ill patients and allows them to spend the final period of their lives in their own homes, together with relatives who can offer them a more empathetic support. Quality of life is closely related to the chance to stay close to loved ones, to reduce the loneliness typical of all forms of hospitalization. The literature consistently demonstrates that the majority of terminally ill patients would prefer to stay and die at home,3,4 but unfortunately, most patients are unable to do so.5 In a prospective review and questionnaire study, Brogaard et al.6 recently showed that most patients declaring a preference concerning where they might receive care and wanted to be cared for (66%–84%) and to die (64%–71%) at home, but only half of them had their wish fulfilled. There also emerges from the literature a significant association between such patients’ wishes being fulfilled and contact with a palliative care team.6 Concerning the efficiency of palliative care services, other studies have demonstrated that changing the focus of care-providing policy from the hospital to the home reduces health-care costs by reducing hospital admissions and the length of hospital stays.7 Costantini et al.8 found the difference in the length of stay particularly evident in
the last 6 months before death. Alonso-Babarro et al.9 found that, when an appropriate palliative home-care team (PHCT) was available, there were fewer deaths in hospital and a drop in the overall hospitalization rates for patients in the last 2 months of their life. Numerous studies from around the world were reviewed by Gomes and Higginson,10 who analyzed the factors (relating to the illness, individual characteristics, the health-care input and social support) affecting the place where terminally ill cancer patients die: there was consistent evidence of the influence of several factors on the place of death, and six of these factors were strongly associated with death at home, that is, patients’ functional status, their preferences, the availability of home care and its intensity, living with relatives, and extended family support.
Aim The aim of this study was to assess the impact of appropriate home-based palliative care in reducing hospitalizations, and also to identify factors predicting the chances of patients in the care of a PHCT at home having to be hospitalized or dying at home.
Methods Context The Italian National Health Service (NHS) is funded mainly through taxes and provides universal access to health services. Primary care lies at the core of the NHS.
Downloaded from pmj.sagepub.com at GEORGE MASON UNIV on July 1, 2014
405
Riolfi et al. General practitioners (GPs) act as gatekeepers to the health system. In each of the 21 regions of Italy, Local Health Authorities (LHAs) are responsible for the delivery of primary care provided by GPs to a geographically designated population. Traditionally, GPs have worked in solo practices. However, in the last 10 years, in an effort to increase coordination of care, the Italian NHS has introduced substantial reforms seeking to encourage collaborative arrangements among GPs and with other kind of physicians or other health-care personnel. In Italy, there is a law (L.38 15/04/2010)11 that ratifies the right of terminally ill patients to be treated and to die at home in the care of a team of GP, specialists, and nurses. The LHA No. 5 in Veneto Region (serving a population of 179,783) set up a PHCT in 2011. The team of this LHA consists of 2 palliative care physicians and 30 nonspecialist nurses, who cooperate with GPs. GPs have to guarantee their on-call availability, and they do not always recommend activating home care for their patients, either because of the burden of this kind of care or because they do not recognize the terminal phase of illness. The intensity of care depends on the patient’s condition: at least one specialist medical examination a week is guaranteed for all terminally ill patients being cared for at home, and this specialist medical examination is conducted daily in the last days of life. Nurses are called in to deal with any need for medication or infusion therapies. The services of a palliative care physician or nurse are assured from Monday to Friday (8.00 a.m. to 20.00 p.m.). On Saturdays and Sundays, there is a nurse on call (8.00 a.m. to 20.00 p.m.). During the night and weekends, patients, caregivers, and colleagues can always contact a palliative care physician by phone. The features defining a terminally ill patient were as follows: the absence of life-prolonging cancer treatment, ruled out by an oncologist; a predicted life expectancy of no more than 3 months; and patients’ and/ or their family members’ explicit consent to treatment at home.
Patients and materials This was a retrospective cohort study enrolling all 402 patients who died with cancer as the first cause of death in 2011 in the area served by the LHA No. 5 in the Veneto Region of north-east Italy. During the first semester of 2012, the study collected information from administrative databases such as the ISTAT (Italian Statistics Institute) death registry and hospital discharge records, and from the palliative care team’s data. The ISTAT death registry also records the place of death and patients’ demographic data. For each case identified, details of the patient’s hospital admissions (number and length of stay) in the last 2 months of life were obtained from the hospital discharge records. The data recorded by the PHCT on the palliative care provided for patients at home
concerned the presence of symptoms (“yes” or “no”), including pain, dysphagia, asthenia, dyspnea, cognitive impairment, wheezing, delirium; the Karnofsky Performance Status score; the patients’ awareness of their condition (dummy “disease and incurability,” “only of the diagnosis,” or “none”); the period of time spent in the care of the PHCT; the number of days when at least one health professional provided care at home; the PHCT service rate (i.e. the sum of the days spent at home in the PHCT’s care/number of days on which at least one health professional provided care at home); the need for therapeutic benzodiazepine sedation (“yes” or “no”); and the need for opioid therapy (“yes” or “no”). Approval for the study was obtained from the Ethical Committee of the Vicenza Provincial Authorities.
Statistical methods All categories of tumors were considered separately in our descriptive analysis, but for the purposes of the inference analysis, any cancers with fewer than 20 cases were grouped into a category defined as “others.” Data were summarized as means with standard deviations for continuous variables, and as numbers (percentages) of patients for categorical variables. The χ2 was used to identify any significant differences in the frequency distribution of categorical variables by group, and student’s t-test was used to assess differences in means by group. Adjusted odds ratios (ORs) with 95% confidence intervals were calculated with a logistic regression model with death at home as the dependent variable, and being taken into the PHCT’s care as the independent variable (yes or no). The other covariates included in the model were as follows: age, sex, and type of cancer (a dummy variable with lung cancer as the reference category). A linear regression analysis was also performed with length of hospital stay as the dependent variable and being taken into the PHCT’s care as the independent variable (yes or no). The other covariates included in the model were the same as those listed above. A Poisson regression analysis was also performed with the number of hospital admissions as the dependent variable and being taken into the PHCT’s care as the independent variable (yes or no). The other covariates included in the models were the same as those listed above. A logistic regression model was used to identify predictors of death at home among the patients taken into care by the PHCT, using death at home as the dependent variable, and the following independent variables: age, sex, symptoms (pain, dysphagia, asthenia, dyspnea, cognitive impairment, wheezing, delirium), the patients’ awareness of their condition (“disease and incurability,” “only of the diagnosis,” or “none”), period in the care of the PHCT, therapeutic sedation (yes or no), Karnofsky Performance Status, and type of cancer (with lung cancer as the reference category),
Downloaded from pmj.sagepub.com at GEORGE MASON UNIV on July 1, 2014
406
Palliative Medicine 28(5)
Table 1. Bivariate analysis of the sample’s characteristics and outcomes by type of care group.
Sex Age Cancer
Place of death
Time spent in hospital in last 2 months of life Number of hospitalizations in last 2 months of life
Male, % (n) Mean age (±SD) Lung, % (n) Colorectal, % (n) Pancreas, % (n) Breast, % (n) HCC, % (n) Prostate, % (n) Hematological, % (n) Unknown, % (n) Others, % (n) Hospital, % (n) Home, % (n) Nursing home, % (n) Country hospital, % (n) Mean days (±SD)
Total sample (N = 402)
Not given palliative care (n = 242)
Given palliative care (n = 160)
p value
58.5% (235) 73.9 (±11.9) 22.1% (89) 11.7% (47) 7.2% (29) 5.2% (21) 6.5% (26) 5.0 % (20) 9.5 % (38) 1.8% (7) 31.1% (125) 53.5% (215) 26.1% (105) 10.7% (43) 9.7% (39)
57.4% (139) 75.1 (±11.9) 19.8% (48) 12.4% (30) 4.6% (11) 5.8% (14) 6.2% (15) 4.1% (10) 13.2% (32) 2.1% (5) 31.8% (77) 73.6% (178) 7.9% (19) 12.4% (30) 6.2% (15)
60.0% (96) 72.1 (±11.9) 25.6% (41) 10.6% (17) 11.2% (18) 4.4% (7) 6.9% (11) 6.2% (10) 3.8% (6) 1.3% (2) 30.0% (48) 23.1% (37) 53.8% (86) 8.1% (13) 15.0% (24)
0.610 0.012 0.017
13.4 (±17.6)
19.6 (±18.9)
4.4 (±10.4)
Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: A retrospective cohort study Mirko Riolfi, Alessandra Buja, Chiara Zanardo, Chiara Francesca Marangon, Pietro Manno and Vincenzo Baldo Palliat Med 2014 28: 403 originally published online 23 December 2013 DOI: 10.1177/0269216313517283 The online version of this article can be found at: http://pmj.sagepub.com/content/28/5/403
Published by: http://www.sagepublications.com
Additional services and information for Palliative Medicine can be found at: Email Alerts: http://pmj.sagepub.com/cgi/alerts Subscriptions: http://pmj.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Apr 22, 2014 OnlineFirst Version of Record - Dec 23, 2013 What is This?
Downloaded from pmj.sagepub.com at GEORGE MASON UNIV on July 1, 2014
517283 research-article2013
PMJ0010.1177/0269216313517283Palliative MedicineRiolfi et al.
Original Article
Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: A retrospective cohort study
Palliative Medicine 2014, Vol. 28(5) 403–411 © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269216313517283 pmj.sagepub.com
Mirko Riolfi1, Alessandra Buja2, Chiara Zanardo2, Chiara Francesca Marangon1, Pietro Manno1 and Vincenzo Baldo2
Abstract Background: It has been demonstrated that most patients in the terminal stages of cancer would benefit from palliative home-care services. Aim: The aim of this study was to assess the effectiveness of appropriate palliative home-care services in reducing hospital admissions, and to identify factors predicting the likelihood of patients treated at home being hospitalized. Design: Retrospective cohort study. Setting/participants: We enrolled all 402 patients listed by the Local Health Authority No. 5, Veneto Region (NorthEast Italy), as dying of cancer in 2011. Results: Of the cohort considered, 39.9% patients had been taken into care by a palliative home-care team. Irrespective of age, gender, and type of tumor, patients taken into care by the palliative home-care team were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life. Among the patients taken into care by the palliative home-care team, those with hematological cancers and hepatocellular carcinoma were more likely to be hospitalized, and certain symptoms (such as dyspnea and delirium) were predictive of hospitalization. Conclusions: Our study confirms the effectiveness of palliative home care in enabling patients to spend the final period of their lives at home. The services of a palliative home-care team reduced the consumption of hospital resources. This study also provided evidence of some types of cancer (e.g. hematological cancers and hepatocellular carcinoma) being more likely to require hospitalization, suggesting the need to reconsider the pathways of care for these diseases. Keywords Health services research, home-care service, epidemiology, palliative medicine, comparative effectiveness research
1Palliative
Care Team, Distretto Socio Sanitario Azienda ULSS 5 Ovest Vicentino, Arzignano, Italy 2Department of Molecular Medicine, Laboratory of Public Health and Population Studies, Institute of Hygiene, University of Padova, Padova, Italy
Corresponding author: Alessandra Buja, Department of Molecular Medicine, Laboratory of Public Health and Population Studies, Institute of Hygiene, University of Padova, Via Loredan, 18, 35128 Padova, Italy. Email: [email protected]
Downloaded from pmj.sagepub.com at GEORGE MASON UNIV on July 1, 2014
404
Palliative Medicine 28(5)
What is already known about the topic?
•• The World Health Organization (WHO) recommends that all countries adopt a national palliative care policy for providing home-based care. •• The majority of terminally ill patients would prefer to stay and die at home. •• Providing palliative care at home enables patients to spend the final period of their lives in their own homes. What this paper adds?
•• This study confirmed that terminally ill cancer patients, who were recruited and consent to being cared for by a palliative home-care team (PHCT) at home, are more likely to die at home, and to have fewer hospitalizations and shorter hospital stays in the last 2 months of their lives. •• The study found that patients in the care of a PHCT who had certain types of neoplastic disease, for example, hematological cancers and hepatocellular carcinoma, were more likely to be hospitalized. •• The study indicated that certain symptoms, for example, dyspnea, pain, and delirium, were predictive of patients in the care of a PHCT being hospitalized. Implications for practice, theory, or policy
•• The services of a PHCT might reduce the consumption of hospital resources. •• This study revealed the need to reconsider the pathways of care for hematological cancers and hepatocellular carcinoma in terminally ill patients.
Background Nowadays, cancer has become one of the leading causes of death worldwide. Franks et al.1 estimated that 25% of people in the terminal phase of cancer in the United Kingdom will require inpatient palliative care, and 65% will benefit from home-based palliative care. The World Health Organization (WHO) recommends that all countries adopt a national palliative care policy as a human right, providing different resources and settings, including home-based care.2 Providing palliative care at home preserves the dignity of terminally ill patients and allows them to spend the final period of their lives in their own homes, together with relatives who can offer them a more empathetic support. Quality of life is closely related to the chance to stay close to loved ones, to reduce the loneliness typical of all forms of hospitalization. The literature consistently demonstrates that the majority of terminally ill patients would prefer to stay and die at home,3,4 but unfortunately, most patients are unable to do so.5 In a prospective review and questionnaire study, Brogaard et al.6 recently showed that most patients declaring a preference concerning where they might receive care and wanted to be cared for (66%–84%) and to die (64%–71%) at home, but only half of them had their wish fulfilled. There also emerges from the literature a significant association between such patients’ wishes being fulfilled and contact with a palliative care team.6 Concerning the efficiency of palliative care services, other studies have demonstrated that changing the focus of care-providing policy from the hospital to the home reduces health-care costs by reducing hospital admissions and the length of hospital stays.7 Costantini et al.8 found the difference in the length of stay particularly evident in
the last 6 months before death. Alonso-Babarro et al.9 found that, when an appropriate palliative home-care team (PHCT) was available, there were fewer deaths in hospital and a drop in the overall hospitalization rates for patients in the last 2 months of their life. Numerous studies from around the world were reviewed by Gomes and Higginson,10 who analyzed the factors (relating to the illness, individual characteristics, the health-care input and social support) affecting the place where terminally ill cancer patients die: there was consistent evidence of the influence of several factors on the place of death, and six of these factors were strongly associated with death at home, that is, patients’ functional status, their preferences, the availability of home care and its intensity, living with relatives, and extended family support.
Aim The aim of this study was to assess the impact of appropriate home-based palliative care in reducing hospitalizations, and also to identify factors predicting the chances of patients in the care of a PHCT at home having to be hospitalized or dying at home.
Methods Context The Italian National Health Service (NHS) is funded mainly through taxes and provides universal access to health services. Primary care lies at the core of the NHS.
Downloaded from pmj.sagepub.com at GEORGE MASON UNIV on July 1, 2014
405
Riolfi et al. General practitioners (GPs) act as gatekeepers to the health system. In each of the 21 regions of Italy, Local Health Authorities (LHAs) are responsible for the delivery of primary care provided by GPs to a geographically designated population. Traditionally, GPs have worked in solo practices. However, in the last 10 years, in an effort to increase coordination of care, the Italian NHS has introduced substantial reforms seeking to encourage collaborative arrangements among GPs and with other kind of physicians or other health-care personnel. In Italy, there is a law (L.38 15/04/2010)11 that ratifies the right of terminally ill patients to be treated and to die at home in the care of a team of GP, specialists, and nurses. The LHA No. 5 in Veneto Region (serving a population of 179,783) set up a PHCT in 2011. The team of this LHA consists of 2 palliative care physicians and 30 nonspecialist nurses, who cooperate with GPs. GPs have to guarantee their on-call availability, and they do not always recommend activating home care for their patients, either because of the burden of this kind of care or because they do not recognize the terminal phase of illness. The intensity of care depends on the patient’s condition: at least one specialist medical examination a week is guaranteed for all terminally ill patients being cared for at home, and this specialist medical examination is conducted daily in the last days of life. Nurses are called in to deal with any need for medication or infusion therapies. The services of a palliative care physician or nurse are assured from Monday to Friday (8.00 a.m. to 20.00 p.m.). On Saturdays and Sundays, there is a nurse on call (8.00 a.m. to 20.00 p.m.). During the night and weekends, patients, caregivers, and colleagues can always contact a palliative care physician by phone. The features defining a terminally ill patient were as follows: the absence of life-prolonging cancer treatment, ruled out by an oncologist; a predicted life expectancy of no more than 3 months; and patients’ and/ or their family members’ explicit consent to treatment at home.
Patients and materials This was a retrospective cohort study enrolling all 402 patients who died with cancer as the first cause of death in 2011 in the area served by the LHA No. 5 in the Veneto Region of north-east Italy. During the first semester of 2012, the study collected information from administrative databases such as the ISTAT (Italian Statistics Institute) death registry and hospital discharge records, and from the palliative care team’s data. The ISTAT death registry also records the place of death and patients’ demographic data. For each case identified, details of the patient’s hospital admissions (number and length of stay) in the last 2 months of life were obtained from the hospital discharge records. The data recorded by the PHCT on the palliative care provided for patients at home
concerned the presence of symptoms (“yes” or “no”), including pain, dysphagia, asthenia, dyspnea, cognitive impairment, wheezing, delirium; the Karnofsky Performance Status score; the patients’ awareness of their condition (dummy “disease and incurability,” “only of the diagnosis,” or “none”); the period of time spent in the care of the PHCT; the number of days when at least one health professional provided care at home; the PHCT service rate (i.e. the sum of the days spent at home in the PHCT’s care/number of days on which at least one health professional provided care at home); the need for therapeutic benzodiazepine sedation (“yes” or “no”); and the need for opioid therapy (“yes” or “no”). Approval for the study was obtained from the Ethical Committee of the Vicenza Provincial Authorities.
Statistical methods All categories of tumors were considered separately in our descriptive analysis, but for the purposes of the inference analysis, any cancers with fewer than 20 cases were grouped into a category defined as “others.” Data were summarized as means with standard deviations for continuous variables, and as numbers (percentages) of patients for categorical variables. The χ2 was used to identify any significant differences in the frequency distribution of categorical variables by group, and student’s t-test was used to assess differences in means by group. Adjusted odds ratios (ORs) with 95% confidence intervals were calculated with a logistic regression model with death at home as the dependent variable, and being taken into the PHCT’s care as the independent variable (yes or no). The other covariates included in the model were as follows: age, sex, and type of cancer (a dummy variable with lung cancer as the reference category). A linear regression analysis was also performed with length of hospital stay as the dependent variable and being taken into the PHCT’s care as the independent variable (yes or no). The other covariates included in the model were the same as those listed above. A Poisson regression analysis was also performed with the number of hospital admissions as the dependent variable and being taken into the PHCT’s care as the independent variable (yes or no). The other covariates included in the models were the same as those listed above. A logistic regression model was used to identify predictors of death at home among the patients taken into care by the PHCT, using death at home as the dependent variable, and the following independent variables: age, sex, symptoms (pain, dysphagia, asthenia, dyspnea, cognitive impairment, wheezing, delirium), the patients’ awareness of their condition (“disease and incurability,” “only of the diagnosis,” or “none”), period in the care of the PHCT, therapeutic sedation (yes or no), Karnofsky Performance Status, and type of cancer (with lung cancer as the reference category),
Downloaded from pmj.sagepub.com at GEORGE MASON UNIV on July 1, 2014
406
Palliative Medicine 28(5)
Table 1. Bivariate analysis of the sample’s characteristics and outcomes by type of care group.
Sex Age Cancer
Place of death
Time spent in hospital in last 2 months of life Number of hospitalizations in last 2 months of life
Male, % (n) Mean age (±SD) Lung, % (n) Colorectal, % (n) Pancreas, % (n) Breast, % (n) HCC, % (n) Prostate, % (n) Hematological, % (n) Unknown, % (n) Others, % (n) Hospital, % (n) Home, % (n) Nursing home, % (n) Country hospital, % (n) Mean days (±SD)
Total sample (N = 402)
Not given palliative care (n = 242)
Given palliative care (n = 160)
p value
58.5% (235) 73.9 (±11.9) 22.1% (89) 11.7% (47) 7.2% (29) 5.2% (21) 6.5% (26) 5.0 % (20) 9.5 % (38) 1.8% (7) 31.1% (125) 53.5% (215) 26.1% (105) 10.7% (43) 9.7% (39)
57.4% (139) 75.1 (±11.9) 19.8% (48) 12.4% (30) 4.6% (11) 5.8% (14) 6.2% (15) 4.1% (10) 13.2% (32) 2.1% (5) 31.8% (77) 73.6% (178) 7.9% (19) 12.4% (30) 6.2% (15)
60.0% (96) 72.1 (±11.9) 25.6% (41) 10.6% (17) 11.2% (18) 4.4% (7) 6.9% (11) 6.2% (10) 3.8% (6) 1.3% (2) 30.0% (48) 23.1% (37) 53.8% (86) 8.1% (13) 15.0% (24)
0.610 0.012 0.017
13.4 (±17.6)
19.6 (±18.9)
4.4 (±10.4)
