Effectiveness of Two Types of Palliative Home Care in Cancer and Non-cancer Patients: A Retrospective Population-based Study Using Claims Data

Overview

Journal Palliat Med

Publisher Sage Publications

Specialty Critical Care

Date 2021 Jun 7

PMID 34092140

Citations 10

Authors

Markus Krause

Bianka Ditscheid

Thomas Lehmann

Maximiliane Jansky

Ursula Marschall

Winfried Meissner

Friedemann Nauck

Ulrich Wedding

Antje Freytag

Affiliations

Soon will be listed here.

Abstract

Background: Comparative effectiveness of different types of palliative homecare is sparsely researched internationally-despite its potential to inform necessary decisions in palliative care infrastructure development. In Germany, specialized palliative homecare delivered by multi-professional teams has increased in recent years and factors beyond medical need seem to drive its involvement and affect the application of primary palliative care, delivered by general practitioners who are supported by nursing services.

Aim: To compare effectiveness of primary palliative care and specialized palliative homecare in reducing potentially aggressive interventions at the end-of-life in cancer and non-cancer.

Design: Retrospective population-based study with claims data from 95,962 deceased adults in Germany in 2016 using multivariable regression analyses.

Settings/participants: Patients having received primary palliative care or specialized palliative homecare (alone or in addition to primary palliative care), for at least 14 days before death, differentiating between cancer and non-cancer patients.

Results: Rates of potentially aggressive interventions in most indicators were higher in primary palliative care than in specialized palliative homecare ( < 0.01), in both cancer and non-cancer patients: death in hospital (odds ratio (OR) 4.541), hospital care (OR 2.720), intensive care treatment (OR 6.749), chemotherapy (OR 2.173), and application of a percutaneous endoscopic gastrostomy (OR 4.476), but not for parenteral nutrition (OR 0.477).

Conclusion: Specialized palliative homecare is more strongly associated with reduction of potentially aggressive interventions than primary palliative care in the last days of life. Future research should identify elements of specialized palliative homecare applicable for more effective primary palliative care, too. German Clinical Trials Register (DRKS00014730).

Citing Articles

Utilization and quality of primary and specialized palliative homecare in nursing home residents vs. community dwellers: a claims data analysis.

Poeck J, Meissner F, Ditscheid B, Krause M, Wedding U, Gebel C BMC Palliat Care. 2025; 24(1):3.

PMID: 39762816 PMC: 11706154. DOI: 10.1186/s12904-024-01631-z.

Psychological stress of general practitioners in the care of patients with palliative care needs: an exploratory study.

Lopez V, der Keylen P, Kuhlein T, Sebastiao M BMC Palliat Care. 2024; 23(1):197.

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Evaluating palliative care case conferences in primary care for patients with advanced non-malignant chronic conditions: a cluster-randomised controlled trial (KOPAL).

Mallon T, Schulze J, Dams J, Weber J, Asendorf T, Bottcher S Age Ageing. 2024; 53(5).

PMID: 38783755 PMC: 11116821. DOI: 10.1093/ageing/afae100.

Utilization and quality of palliative care in patients with hematological and solid cancers: a population-based study.

Gebel C, Ditscheid B, Meissner F, Slotina E, Kruschel I, Marschall U J Cancer Res Clin Oncol. 2024; 150(4):191.

PMID: 38607376 PMC: 11014814. DOI: 10.1007/s00432-024-05721-6.

Symptom and problem clusters in German specialist palliative home care - a factor analysis of non-oncological and oncological patients' symptom burden.

Gesell D, Hodiamont F, Wikert J, Lehmann-Emele E, Bausewein C, Nauck F BMC Palliat Care. 2023; 22(1):183.

PMID: 37978356 PMC: 10655459. DOI: 10.1186/s12904-023-01296-0.

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