PaCES-Non-cancer

Investigation of palliative care and healthcare resource use among people living with non-cancer illnesses

smiling woman and man walking together outside

Equity in Non-Cancer: Identifying the Equity Gaps in Palliative Care Access for Albertans Living with Non-Cancer Diagnoses

Background 
Health disparities in Alberta are a continuing reality. For patients living with serious illnesses, timely palliative care access is beneficial in improving their quality of life and shifting care to the community near end of life. But nationally and internationally there are discrepancies in these outcomes based on various equity factors. Equity factors of interest include age, sex, comorbidities, type of non-cancer diagnosis, income level, education level, ethnicity, vulnerably housed, rural or urban living location. In a sustainable health system, it is critically important to know exactly which groups of Albertans are receiving no or late palliative care, and who have high use of potentially inappropriate hospital-based care at end of life. That way, resources can be highly targeted to those areas of need. 

The specific objectives of the project are as follows: 

1. What are the disparities in access to supportive and palliative care among Albertans living with advanced non-cancer diagnoses? 

2. What is the relationship between socioeconomic and other equity factors, on access to supportive and palliative care, AND end-of-life outcomes amongst Albertans living with advanced non-cancer diagnoses

Methods 
This will be a retrospective cohort study of Alberta residents (18 years of age and older) who have died of a non-cancer diagnosis between Jan 1, 2012 and Dec 31, 2021, using data from multiple Alberta health databases. We will also link to Statistics Canada database to pull postal code level socioeconomic factors (such as income and education level) and the Pampolon Index. Persons experiencing homelessness will be identified using a validated Ontario health administrative data algorithm. Outcomes of interest are: a) Access to palliative care (i.e., palliative care services and consultations used at home, hospital and care facilities and hospice) and b) End-of-life healthcare resource use (hospital days, hospital death, emergency department visits). Descriptive statistics will be used to report on these outcomes with sub-group analyses by the equity factors of interest (socioeconomic status, education, homelessness, rurality, ethnicity/language spoken). Multivariable logistic regression will be used to adjust by these equity factors to assess outcomes. 

Significance 
If identified, gaps in care can begin to be addressed by increasing awareness and motivating health care policy and provider behavior change. Findings from this study will also be communicated to relevant groups to help inform the design and planning of community- and hospital-based health care resources and their allocation, to best match the needs of chronic disease patients transitioning from treatment to palliative care and supportive care services.

Funding
This research is supported by a grant from the Government of Alberta. 


Investigation of healthcare resource use at end of life in chronic disease patients in Calgary Zone

Most Albertans die of chronic diseases such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes. The long term goal of this project is to ensure that these patients are receiving the best possible healthcare at the end of life. Research and experience show that palliative care is a key ingredient to doing this. Palliative care addresses patients’ unmet needs around illness comprehension and coping, advance care planning and decision making, symptoms and daily functioning, and coordination of care.

In Alberta, very few chronic disease patients appear to access palliative care services. It is not clear why this is the case. This study focused on producing a detailed description of palliative care service use by patients who died of a chronic disease in the Calgary area (Calgary Zone) from 2003-2016. Using administrative healthcare data, we have described which chronic disease patients are mostly likely to get palliative care (and the timing of palliative care), and the impact palliative care had on a patient's risk of experiencing aggressive end-of-life care. This analysis is critical in identifying patient populations with the highest burden and greatest unmet needs (based on healthcare resource use in the last year of life).

Funding
This research was supported by a grant from the MSI Foundation. 

Publications
Mracek J, Earp M, Sinnarajah S. Palliative home care and emergency department visits in the last 30 and 90 days of life: a retrospective cohort study of patients with cancer. BMJ Support Palliat Care 2021 Jun 29;bmjspcare-2021-002889. doi: 10.1136/bmjspcare-2021-002889.  Online ahead of print.

Earp M, Cai P, Fong A, Blacklaws K, Pham TM, Shack L, Sinnarajah A. Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups. BMJ Open 2021; 11(3): e044196.