Cancer patients have a reduced likelihood of dying in hospital with advance care planning in primary health care and a summarizing palliative plan: a prospective controlled non-randomized intervention trial

Scand J Prim Health Care. 2024 Sep;42(3):471-482. doi: 10.1080/02813432.2024.2346131. Epub 2024 Apr 25.

Abstract

Background: Advance care planning (ACP) allows patients to define their goals and preferences. Spending more time at home and less time in the hospital, along with avoiding death in the hospital, are often considered desirable outcomes of palliative care (PC). In 2015, 36% of cancer patients died in the hospital and 13% died at home in Norway.

Method: From 2015 to 2022, this prospective controlled non-randomized intervention trial observed 144 cancer patients with or without an organized ACP conversation in primary health care and a summarizing palliative plan (ClinicalTrials.gov Identifier: NCT02170168, 23 June 2014). The patients were identified through contact with the local cancer outpatient clinic or hospital-based PC team.

Results: A total of 128 patients died during the observation period. Of these, 67 patients had an organized ACP conversation and summarizing palliative plan (intervention (I) group) and 61 had not (control (C) group). Dying in the hospital was significantly less common for patients in the I group compared to the C group (17.9% vs. 34.4%; X2 (1, n = 128) = 4.55, p = 0.033). There were no differences between the groups in terms of where they spent their time in the last 90 days of life (home, nursing home, or hospital). Most patients (62%) preferred to die at home. The observed differences between the groups regarding preferred and actual places of death did not reach statistical significance.

Conclusion: With organized ACP conversations in primary health care and a summarizing palliative plan, cancer patients died less often in the hospital in our observational study. A structured ACP approach integrating palliative care for cancer patients into primary health care can support patients´ preferences at the end of life.

Keywords: Advance care planning; actual place of death; cancer; home care; palliative care; place of death; preferred place of death; primary health care.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Advance Care Planning*
  • Aged
  • Aged, 80 and over
  • Communication
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Neoplasms* / mortality
  • Neoplasms* / therapy
  • Norway
  • Palliative Care*
  • Patient Preference
  • Primary Health Care*
  • Prospective Studies
  • Terminal Care

Associated data

  • ClinicalTrials.gov/NCT02170168

Grants and funding

The Norwegian Directorate of Health funded the development and implementation of ACP conversations and summarizing palliative plans in Møre and Romsdal County. This study was supported by Møre and Romsdal Hospital Trust, and Norwegian University of Science and Technology (NTNU). The funding bodies played no role in the design of the study, collection, analysis, interpretation of data, or writing of the manuscript.