clinical focus time before death, but this study suggests there may be a benefit for both the patient and the health system for this support to be provided at home earlier.
“ As populations age, strategic planning of palliative care will be important to ensure the quality and sustainability of end-of-life care.”
Aged Care Insite spoke with Wright about the benefits of and downsides to providing palliative care earlier and what he hopes policymakers do with the findings.
Palliative rethink
Starting palliative care sooner could help keep people out of hospital.
Cameron Wright interviewed by Dallas Bastian
Providing earlier access to palliative care could see fewer hospital admissions at the end of life and lower healthcare costs, research has found.
Study lead Cameron Wright, from the School of Public Health at Curtin University, said the findings were important given the wish among many people receiving palliative care to die at home.
The research, published in the Journal of Pain and Symptom
Management, examined the care of 16,439 people who died from cancer in Western Australia between 2001 and 2011, and accessed community-based palliative care services.
Wright and his colleagues found that offering community-based palliative care to a person before the last six months of their life was linked with a lower rate of unplanned hospitalisations in that last six months as well as lower healthcare costs.
He said:“ This study suggests a link between accessing community-based palliative care earlier and fewer unplanned hospitalisation and emergency department presentations, as well as lower associated healthcare costs in the final 12 months of a person’ s life.
“ In some parts of the world, including the US, access to community-based palliative care is restricted to a certain expected
ACI: Offering community-based palliative care to a person before the last six months of their life was linked to a lower rate of unplanned hospitalisations in that last six months. What were some of the other benefits to people receiving palliative care earlier, and to the health system? CW: Yes, you’ re quite right that the findings were that, looking at the last six months of life, there were on average lower rates of hospitalisation. For this study, we did look at the last one month, three months and 12 months of life as well, and the relationship for all of the time periods was a little bit messier than when my colleagues – David Youens and Rachael Moorin – looked at just comparing palliative care to no palliative care. You kind of expect that when you look into that level of detail.
So aside from the sort of over the past six months, the reduced on average rate of hospitalisation, we did find that overall there probably was less acute care costs. This was estimated by looking at the average cost per admission type for people needing to go into hospital.
We also found that people tended to have less ED presentations. Really this was a subset of the people who were admitted to hospital. So we look at the graph we came up with for hospital use and ED presentations – ED presentations followed the same trajectory and act as a subset of people who were subsequently admitted to hospital.
In terms of benefits to people and in terms of the quality of palliative care, we do know that the World Health Organization does recommend palliative care be available and that it be available early in the course of illness. Of course, that will vary from person to person, and situation to situation in terms of palliative care really being a change in focus from a curative aim to a patient comfort and symptom management aim. But really this study looked at the acute care use and the associated costs. There is a body of research beyond our study that does look at the quality-of-life benefits and those benefits to individual patients from high-quality palliative care being available.
Were there any downsides to the individual or to the health system to offering palliative care earlier? Again, our study didn’ t focus on the downsides outside of resource allocation. Interestingly, we did find that people who were admitted to hospital tended to stay a bit longer on average. This was an interesting finding for us. A difficulty with this study being an observational study, as opposed to a trial comparing two treatments, for instance, is we can’ t say that earlier initiation or late initiation caused the effects that we observed. We can only say that they were associated.
We did have an interesting finding in terms of people perhaps staying for a little bit longer. Of course, there are different reasons that this might be. It might be that people were admitted to hospital for complex things that couldn’ t be managed at the community level, and so they were, on average, a bit sicker than people who weren’ t receiving community-based palliative care.
26 agedcareinsite. com. au