End-of-life care in individuals with respiratory diseases: a population study comparing the dying experience between those with chronic obstructive pulmonary disease and lung cancer
Received 5 April 2019
Accepted for publication 10 July 2019
Published 31 July 2019 Volume 2019:14 Pages 1691—1701
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Tetyana Kendzerska,1,2 Jason W Nickerson,3,4 Amy T Hsu,1–3 Andrea S Gershon,5 Robert Talarico,1,2 Sunita Mulpuru,1 Smita Pakhale,1 Peter Tanuseputro1–3
1Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; 2ICES, Ottawa, Ontario, Canada; 3Bruyère Research Institute, Ottawa, Ontario, Canada; 4Centre for Health Law, Policy and Ethics, Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada; 5Department of Medicine, the Sunnybrook Health Science Center/ICES, Toronto, Ontario, Canada
Purpose: Among individuals with COPD and/or lung cancer, to describe end-of-life health service utilization, costs, and place of death; to identify predictors of home palliative care use, and to assess benefits associated with palliative care use.
Patients and methods: We conducted a retrospective population-based study using provincial linked health administrative data (Ontario, Canada) between 2010 and 2015. We examined health care use in the last 90 days of life in adults 35 years and older with physician-diagnosed COPD and/or lung cancer identified using a validated algorithm and the Ontario Cancer Registry, respectively. Four mutually exclusive groups were considered: (i) COPD only, (ii) lung cancer only, (iii) COPD and lung cancer, and (iv) neither COPD nor lung cancer. Multivariable generalized linear models were employed.
Results: Of 445,488 eligible deaths, 34% had COPD only, 4% had lung cancer only, 5% had both and 57% had neither. Individuals with COPD only received less palliative care (20% vs 57%) than those with lung cancer only. After adjustment, people with lung cancer only were far more likely to receive palliative care (OR=4.22, 4.08–4.37) compared to those with neither diagnosis, while individuals with COPD only were less likely to receive palliative care (OR=0.82, 0.81–0.84). Home palliative care use was associated with reduced death and fewer days in acute care, and less cost, regardless of the diagnosis.
Conclusion: Although individuals with lung cancer were much more likely to receive palliative care than those with COPD, both populations were underserviced. Results suggest greater involvement of palliative care may improve the dying experience of these populations and reduce costs.
Keywords: pulmonary disease, chronic obstructive, lung neoplasms, palliative care, health services
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