Variations in specialist palliative care referrals: findings from a population-based patient cohort of acute myeloid leukaemia, diffuse large B-cell lymphoma and myeloma

TY - JOUR

T1 - Variations in specialist palliative care referrals

T2 - findings from a population-based patient cohort of acute myeloid leukaemia, diffuse large B-cell lymphoma and myeloma

AU - Howell, Debra

AU - Wang, Han I

AU - Roman, Eve

AU - Smith, Alexandra Gwen

AU - Patmore, R.

AU - Johnson, Miriam

AU - Garry, A.

AU - Howard, M. R.

PY - 2015

Y1 - 2015

N2 - Objective To develop and implement a methodology for capturing completehaematological malignancy pathway data and use it to identify variations in specialist palliative care (SPC) referrals. Methods In our established UK populationbased patient cohort, 323 patients were diagnosed with acute myeloid leukaemia, diffuse large B-cell lymphoma or myeloma between May 2005 and April 2008, and died before April 2010. A day-by-day calendar approach was devised to collect pathway data, including SPC referrals, to supplement routinely collected information on clinical presentation, diagnosis, treatment, response, and date and place of death. Results 155 (47.9%) of the 323 patients had at least one SPC referral. The likelihood of referral increased with survival (OR 6.58, 95% CIs 3.32 to 13.03 for patients surviving ≥1 year compared to ≤1 month from diagnosis), and varied with diagnosis (OR 1.96, CIs 1.15 to 3.35 for myelomacompared to acute myeloid leukaemia). Compared to patients dying in hospital, those who died at home or in a hospice were also more likely to have had an SPC referral (OR 3.07, CIs 1.59 to 5.93 and 4.74, CIs 1.51 to 14.81, respectively). No associations were found for age and sex. Conclusions Our novel approach efficiently captured pathway data and SPC referrals, revealing evidence of greater integration between haematology and SPC services than previously reported. The likelihood of referral was much higher among those dying outside hospital, andvariations in practice were observed by diagnosis, emphasising the importance of examining diseases individually.

AB - Objective To develop and implement a methodology for capturing completehaematological malignancy pathway data and use it to identify variations in specialist palliative care (SPC) referrals. Methods In our established UK populationbased patient cohort, 323 patients were diagnosed with acute myeloid leukaemia, diffuse large B-cell lymphoma or myeloma between May 2005 and April 2008, and died before April 2010. A day-by-day calendar approach was devised to collect pathway data, including SPC referrals, to supplement routinely collected information on clinical presentation, diagnosis, treatment, response, and date and place of death. Results 155 (47.9%) of the 323 patients had at least one SPC referral. The likelihood of referral increased with survival (OR 6.58, 95% CIs 3.32 to 13.03 for patients surviving ≥1 year compared to ≤1 month from diagnosis), and varied with diagnosis (OR 1.96, CIs 1.15 to 3.35 for myelomacompared to acute myeloid leukaemia). Compared to patients dying in hospital, those who died at home or in a hospice were also more likely to have had an SPC referral (OR 3.07, CIs 1.59 to 5.93 and 4.74, CIs 1.51 to 14.81, respectively). No associations were found for age and sex. Conclusions Our novel approach efficiently captured pathway data and SPC referrals, revealing evidence of greater integration between haematology and SPC services than previously reported. The likelihood of referral was much higher among those dying outside hospital, andvariations in practice were observed by diagnosis, emphasising the importance of examining diseases individually.

U2 - 10.1136/bmjspcare-2013-000578

DO - 10.1136/bmjspcare-2013-000578

M3 - Article

SN - 1478-9515

VL - 5

SP - 496

EP - 502

JO - Palliative and Supportive Care

JF - Palliative and Supportive Care

IS - 5

ER -