The Impact of Early Palliative Care Decisions on Hospital Service Utilization and End-of-Life Care in Patients with...

ObjectivesEarly palliative care (PC) is recommended in pancreatic cancer but remains underutilized. This study assessed whether the timing of the PC decision affected the hospital resource use and access to specialized PC services. The implementation of an integrated PC (IPC) was also evaluated.MethodsThis retrospective single-center cohort study included 440 deceased pancreatic cancer patients treated at the Comprehensive Cancer Center, Helsinki University Hospital (2017-2018). Patients were categorized by timing of the PC decision-defined as withholding or termination of life-prolonging treatment and transition to PC-into early (>30 days before death) or late/no (≤30 days before death) groups. Hospital resource utilization was obtained from electronic medical records.ResultsA PC decision was made for 87% of patients, median of 1.5 months before death. Chemotherapy was given to 8% during the last month. Compared to early decisions, late/no PC decisions were associated with anticancer treatment closer to death (43 days vs 115 days, p < 0.001), higher acute healthcare use, including double the emergency department visits (61% vs 27%, p < 0.001) and triple the hospitalizations (59% vs 20%, p < 0.001) in the final month. Early PC decision was associated with earlier and more frequent use of the outpatient PC unit (3.6 vs 1 month before death, p < 0.001; 84% vs 61%, p < 0.001). Only 36% received PC integrated with oncologic treatment.ConclusionsLate or absent PC decisions were associated with increased end-of-life hospital interventions and reduced access to specialized PC services; both linked to impaired quality of EOL care and increased healthcare costs.