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Waller A, Sanson-Fisher R, Nair BR, Evans T. Preferences for End-of-Life Care and Decision Making Among Older and Seriously Ill Inpatients: A Cross-Sectional Study. J Pain Symptom Manage 2020; 59:187-196. [PMID: 31539600 DOI: 10.1016/j.jpainsymman.2019.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 12/30/2022]
Abstract
CONTEXT Older and seriously ill Australians are often admitted to hospital in the last year of their life. The extent to which these individuals have considered important aspects of end-of-life (EOL) care, including location in which care is provided, goals of care, and involvement of others in decision making, is unclear. OBJECTIVES To determine, in a sample of older and seriously ill Australian inpatients, preferences regarding location in which they receive EOL care and reasons for their choice; who is involved in EOL decisions; disclosure of life expectancy; goals of care; and voluntary-assisted dying. METHODS Cross-sectional face-to-face survey interviews conducted with 186 (80% consent) inpatients in a tertiary referral center aged 80 years and older; or aged 55 years and older with progressive chronic disease(s); or with physician-estimated life expectancy of less than 12 months. RESULTS Home care was preferred (69%), given the perceived availability of family/friends, familiarity of environment, and likelihood of having wishes respected. If unable to make decisions themselves, inpatients wanted family to decide care alone (31%) or with a doctor (49%). Of those who had not discussed life expectancy, 23% wished to. Most (76%) preferred care that maintained quality of life and relieved symptoms. There was some agreement for being sedated at the EOL (63%) and able to access medication to end life (43%). CONCLUSION Most inpatients would prefer EOL care that maintains quality and relieves suffering compared with life extension and to receive this care at home. Family involvement in resolution and documentation of EOL decisions should be prioritized.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales, Australia.
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Balakrishnan R Nair
- John Hunter Hospital, New Lambton Heights, New South Wales, and the University of Newcastle, Callaghan, New South Wales, Australia
| | - Tiffany Evans
- Clinical Research Design and Statistics Support Unit, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Barbera L, Seow H, Sutradhar R, Chu A, Burge F, Fassbender K, McGrail K, Lawson B, Liu Y, Pataky R, Potapov A. Quality Indicators of End-of-Life Care in Patients With Cancer: What Rate Is Right? J Oncol Pract 2015; 11:e279-87. [PMID: 25922219 DOI: 10.1200/jop.2015.004416] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To develop data-driven and achievable benchmark rates for end-of-life quality indicators using administrative data from four provinces in Canada. METHODS Indicators of end-of-life care were defined and measured using linked administrative data for 33 health regions across British Columbia, Alberta, Ontario, and Nova Scotia. These were emergency department use, intensive care unit admission, physician house calls and home care visits before death, and death in hospital. An empiric benchmark was defined using indicator rates from the top-ranked regions to include the top decile of patients overall. Funnel plots were used to graph each region's age- and sex-adjusted indicator rates along with the overall rate and 95% confidence limits. RESULTS Rates varied approximately two- to four-fold across the regions, with physician house calls showing the greatest variation. Benchmark rates based on the top decile performers were emergency department use, 34%; intensive care unit admission, 2%; physician house calls, 34%; home care visits, 63%; and death in hospital, 38%. With the exception of intensive care unit admission, funnel plots demonstrated that overall indicator rates and their confidence limits were uniformly worse than benchmarks even after adjusting for age and sex. Few regions met the benchmark rates. CONCLUSION There is significant variation in end-of-life quality indicators across regions in four provinces in Canada. Using this study's methods-deriving empiric benchmarks and funnel plots-regions can determine their relative performance with greater context that facilitates priority setting and resource deployment. Applying this study's methods can support quality improvement by decreasing variation and striving for a target.
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Affiliation(s)
- Lisa Barbera
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Hsien Seow
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Rinku Sutradhar
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Anna Chu
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Fred Burge
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Konrad Fassbender
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Kim McGrail
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Beverley Lawson
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Ying Liu
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Reka Pataky
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Alex Potapov
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
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