Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis
Background: Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative care use among patients receiving hemodialysis are unknown. Objectives: We aimed to undertake a current-state analysis...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2018-07-01
|
| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/2054358118783761 |
| _version_ | 1819050409813082112 |
|---|---|
| author | Gihad E. Nesrallah Stephanie N. Dixon Marnie MacKinnon Sarbjit Vanita Jassal Sarah E. Bota Jade S. Dirk Erin Arthurs Peter G. Blake Manish M. Sood Amit X. Garg Sara N. Davison |
| author_facet | Gihad E. Nesrallah Stephanie N. Dixon Marnie MacKinnon Sarbjit Vanita Jassal Sarah E. Bota Jade S. Dirk Erin Arthurs Peter G. Blake Manish M. Sood Amit X. Garg Sara N. Davison |
| author_sort | Gihad E. Nesrallah |
| collection | DOAJ |
| description | Background: Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative care use among patients receiving hemodialysis are unknown. Objectives: We aimed to undertake a current-state analysis to inform measurement and quality improvement in palliative service use in Ontario. Methods: We conducted a descriptive study of outcomes and home palliative care use by Ontario residents maintained on chronic dialysis using multiple provincial healthcare datasets. The period of study was the final year of life, for those died between January 2010 and December 2014. Results: We identified 9611 patients meeting inclusion criteria. At death, patients were (median [Q1, Q3] or %): 75 (66, 82) years old, on dialysis for 3.0 (1.0-6.0) years, 41% were women, 65% had diabetes, 29.6% had dementia, and 13.9% had high-impact neoplasms, and 19.9% had discontinued dialysis within 30 days of death. During the last year of life, 13.1% received ⩾1 home palliative services. Compared with patients who had no palliative services, those who received home palliative care visits had fewer emergency department and intensive care unit visits in the last 30 days of life, more deaths at home (17.1 vs 1.4%), and a lower frequency of deaths with an associated intensive care unit stay (8.1 vs 37.8%). Conclusions: Only a small proportion of patients receiving dialysis in Ontario received support through the home palliative care system. There appears to be an opportunity to improve palliative care support in parallel with dialysis care, which may improve patient, family, and health-system outcomes. |
| first_indexed | 2024-12-21T11:47:36Z |
| format | Article |
| id | doaj.art-5f06ea8cd1b2471ba8c6f3e252a22f42 |
| institution | Directory Open Access Journal |
| issn | 2054-3581 |
| language | English |
| last_indexed | 2024-12-21T11:47:36Z |
| publishDate | 2018-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj.art-5f06ea8cd1b2471ba8c6f3e252a22f422022-12-21T19:05:08ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812018-07-01510.1177/2054358118783761Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic DialysisGihad E. Nesrallah0Stephanie N. Dixon1Marnie MacKinnon2Sarbjit Vanita Jassal3Sarah E. Bota4Jade S. Dirk5Erin Arthurs6Peter G. Blake7Manish M. Sood8Amit X. Garg9Sara N. Davison10Ontario Renal Network, Cancer Care Ontario, Toronto, CanadaFaculty of Medicine and Dentistry, Department of Epidemiology and Biostatistics, Western University, London, Ontario, CanadaOntario Renal Network, Cancer Care Ontario, Toronto, CanadaFaculty of Medicine, University of Toronto, Ontario, CanadaFaculty of Medicine and Dentistry, Department of Epidemiology and Biostatistics, Western University, London, Ontario, CanadaInstitute for Clinical Evaluative Sciences, Toronto, Ontario, CanadaOntario Renal Network, Cancer Care Ontario, Toronto, CanadaFaculty of Medicine and Dentistry, Division of Nephrology and Immunology, Western University, London, Ontario, CanadaOttawa Research Institute, Ontario, CanadaFaculty of Medicine and Dentistry, Division of Nephrology and Immunology, Western University, London, Ontario, CanadaDivision of Nephrology and Immunology, Faculty of Medicine, University of Alberta, Edmonton, CanadaBackground: Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative care use among patients receiving hemodialysis are unknown. Objectives: We aimed to undertake a current-state analysis to inform measurement and quality improvement in palliative service use in Ontario. Methods: We conducted a descriptive study of outcomes and home palliative care use by Ontario residents maintained on chronic dialysis using multiple provincial healthcare datasets. The period of study was the final year of life, for those died between January 2010 and December 2014. Results: We identified 9611 patients meeting inclusion criteria. At death, patients were (median [Q1, Q3] or %): 75 (66, 82) years old, on dialysis for 3.0 (1.0-6.0) years, 41% were women, 65% had diabetes, 29.6% had dementia, and 13.9% had high-impact neoplasms, and 19.9% had discontinued dialysis within 30 days of death. During the last year of life, 13.1% received ⩾1 home palliative services. Compared with patients who had no palliative services, those who received home palliative care visits had fewer emergency department and intensive care unit visits in the last 30 days of life, more deaths at home (17.1 vs 1.4%), and a lower frequency of deaths with an associated intensive care unit stay (8.1 vs 37.8%). Conclusions: Only a small proportion of patients receiving dialysis in Ontario received support through the home palliative care system. There appears to be an opportunity to improve palliative care support in parallel with dialysis care, which may improve patient, family, and health-system outcomes.https://doi.org/10.1177/2054358118783761 |
| spellingShingle | Gihad E. Nesrallah Stephanie N. Dixon Marnie MacKinnon Sarbjit Vanita Jassal Sarah E. Bota Jade S. Dirk Erin Arthurs Peter G. Blake Manish M. Sood Amit X. Garg Sara N. Davison Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis Canadian Journal of Kidney Health and Disease |
| title | Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis |
| title_full | Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis |
| title_fullStr | Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis |
| title_full_unstemmed | Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis |
| title_short | Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis |
| title_sort | home palliative service utilization and care trajectory among ontario residents dying on chronic dialysis |
| url | https://doi.org/10.1177/2054358118783761 |
| work_keys_str_mv | AT gihadenesrallah homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis AT stephaniendixon homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis AT marniemackinnon homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis AT sarbjitvanitajassal homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis AT sarahebota homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis AT jadesdirk homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis AT erinarthurs homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis AT petergblake homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis AT manishmsood homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis AT amitxgarg homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis AT sarandavison homepalliativeserviceutilizationandcaretrajectoryamongontarioresidentsdyingonchronicdialysis |