Original Article
Association Between Referral-to-Death Interval and Location of Death of Patients Referred to a Hospital-Based Specialist Palliative Care Service

https://doi.org/10.1016/j.jpainsymman.2012.08.009Get rights and content
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Abstract

Context

The time interval between palliative care referral and death may play a role in determining the last place of care and location of death of patients referred to palliative care teams.

Objectives

To examine the association between the referral-to-death interval and location of death of patients referred to a hospital-based palliative care service in Singapore.

Methods

A retrospective analysis of data from a palliative care service's administrative database was performed. Individual patient's referral-to-death interval was calculated using the date of first contact with the service and date of death. Multinomial regression analysis was done to determine the influence of referral-to-death interval in predicting death at home and in an inpatient hospice facility compared with death in hospital, separately by gender.

Results

Of 842 patients, 52% were female and 56% were aged 65 years or older. Terminal cancer was the diagnosis for most patients (86%). Three hundred ninety patients (46%) died outside the hospital setting. A referral-to-death interval of ≥30 days (as opposed to <30 days) was associated with an increased likelihood of dying at home (odds ratio [OR] 2.21, 95% CI 1.34–3.67 for males and OR 3.33, 95% CI 2.07–5.35 for females) or in an inpatient hospice facility (OR 2.02, 95% CI 1.13–3.60 for males and OR 2.69, 95% CI 1.55–4.66 for females) compared with death in hospital. Male patients' age, ethnicity, and marital status were found to be the contributing factors in predicting death at home.

Conclusion

Longer referral-to-death interval was associated with death outside the hospital for patients enrolled in a hospital-based service. The study highlights the importance of early referral in predicting the last place of care and location of death of palliative care patients.

Key Words

Palliative care
hospital
timing of referral
place of death
Singapore

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