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. 2024 Apr 10;23(1):93.
doi: 10.1186/s12904-024-01403-9.

Quality of palliative and end-of-life care: a quantitative study of temporal trends and differences according to illness trajectories in Quebec (Canada)

Arnaud Duhoux  1 , Emilie Allard  1 , Denis Hamel  2 , Martin Sasseville  3 , Sarah Dumaine  1 , Morgane Gabet  4 , Marie-Hélène Guertin  2
Affiliations

Quality of palliative and end-of-life care: a quantitative study of temporal trends and differences according to illness trajectories in Quebec (Canada)

Arnaud Duhoux et al. BMC Palliat Care. .

Abstract

Background: Our aim was to assess temporal trends and compare quality indicators related to Palliative and End-of-Life Care (PEoLC) experienced by people dying of cancer (trajectory I), organ-failure (Trajectory II), and frailty/dementia (trajectory III) in Quebec (Canada) between 2002 and 2016.

Methods: This descriptive population-based study focused on the last month of life of decedents who, based on the principal cause of death, would have been likely to benefit from palliative care. Five PEoLC indicators were assessed: home deaths (1), deaths in acute care beds with no PEoLC services (2), at least one Emergency Room (ER) visit in the last 14 days of life (3), ER visits on the day of death (4) and at least one Intensive Care Unit (ICU) admission in the last month of life (5). Data were obtained from Quebec's Integrated Chronic Disease Surveillance System (QICDSS).

Results: The annual percentage of home deaths increased slightly between 2002 and 2016 in Quebec, rising from 7.7 to 9.1%, while the percentage of death during a hospitalization in acute care without palliative care decreased from 39.6% in 2002 to 21.4% in 2016. Patients with organ failure were more likely to visit the ER on the day of death (20.9%) than patients dying of cancer and dementia/frailty with percentages of 12.0% and 6.4% respectively. Similar discrepancies were observed for ICU visits in the last month and ER visits in the last 14 days.

Conclusion: PEoLC indicators showed more aggressiveness of care for patients with organ failure and highlight the need for more equitable access to quality PEoLC between malignant and non-malignant illness trajectories. These results underline the challenges of providing timely and optimal PEoLC.

Keywords: Care access; Care equity; PEoLC; Quality improvement.

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Conflict of interest statement

The authors of this research declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Trends in percentage of home deaths [1] regarding illness trajectories
Fig. 2
Fig. 2
Trends in percentage of deaths in acute care beds with no PEoLC prior to death [2] regarding illness trajectories
See this image and copyright information in PMC

References

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