Palliative care is effective: but hospital symptom outcomes superior

BMJ Supportive & Palliative Care
Kathy EagarSamuel Frederic Allingham

Abstract

To explore differences in severe symptom outcomes for palliative care patients receiving hospital care compared with those receiving care at home. Change in symptom distress from the start of an episode of palliative care to just prior to death was measured for 25 679 patients who died under the care of a hospital or home-based palliative care team between January 2015 and December 2016. Logistic regression models controlled for differences between hospital and home and enabled a comparison of the number of severe symptoms just prior to death. All symptoms improved and over 85% of all patients had no severe symptoms prior to death. Pain control illustrates this with 7.4% of patients reporting severe pain distress at episode start and 2.5% just prior to death. When comparing all symptom outcomes by place of death, hospital patients are 3.7 times more likely than home patients to have no severe symptoms. Symptom outcomes are better for hospital patients. Patients at home have less improvement overall and some symptoms get worse. Reasons for the difference in outcomes by hospital and home are multifactorial and must be considered in relation to the patient's right to choose their place of care.

References

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Sep 27, 2006·Journal of Pain and Symptom Management·Jean S KutnerDiane L Fairclough
May 26, 2010·Australian Health Review : a Publication of the Australian Hospital Association·Kathy EagarPatsy Yates
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May 26, 2016·Journal of Pain and Symptom Management·Magnus EkströmDavid C Currow

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Citations

Apr 25, 2020·Journal of the American Geriatrics Society·Jinfeng DingAngus Cook
Sep 4, 2021·ESMO Open·G B CrawfordUNKNOWN ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org
Jan 2, 2022·BMJ Supportive & Palliative Care·Martins Fideles Dos Santos NetoBianca Sakamoto Ribeiro Paiva

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