Factors associated with utilization of specialist palliative care services: a population based study

Palliative care services have been criticized for providing specialist care for a privileged few but there is no routinely available information to prove or refute these criticisms. Our survey aimed to identify and describe the patients using specialist palliative care services in a Health District and identify whether any factors distinguished them from other eligible patients who did not use these services.

Clinical and demographic data were collected retrospectively for all residents of the Health District who died of cancer during 1991. Comparisons were made between those who used specialist palliative care services and those who did not.

A total of 521 cases were studied of which 157 (30 per cent) had used the specialist palliative care services. These cases (Group 1) compared with the remainder (Group 2) were statistically significantly (p < 0.05) different in terms of their age at death (mean age for Group 1 was 66.6 years, compared with 73 years for Group 2), survival times from diagnosis (median number of days for Group 1 was 242, compared with 110 days for Group 2) and general practitioner practice. There were no significant differences between the two groups for all other variables, i.e. ward of residence, social class, cancer site and gender. Cases in Group 1 were more likely to die at home (39 per cent compared with 27 per cent in Group 2).

Effectiveness studies in the field of palliative care are essential but difficult. We suggest that there is an important place for local studies of needs and utilization for guiding sensitive contracting.