Impact of specialist palliative care on utilization of healthcare and social services at the end-of-life: a nationwide register-based cohort study

Abstract

Non-malignant diseases cause 60% of non-communicable diseases requiring palliative care, yet specialist palliative care services primarily focus on cancer. We investigated end-of-life healthcare and social services utilization among cancer and non-malignant patients, and, secondarily, access to specialist palliative care and its effect on services utilization. This retrospective, nationwide register-based study included all adults (n = 38540) who died from non-communicable life-limiting diseases in Finland in 2019, categorized into neurodegenerative (31%), other non-malignant (36%), and cancer (33%) groups. Hospital was the most common place of death (61%). Healthcare utilization substantially increased during the final weeks of life in all groups but remained highest in cancer patients. Social services utilization was highest in neurodegenerative diseases. Specialist palliative care contact was significantly (P 30days before death) compared to late/no specialist palliative care contact significantly reduced emergency care contacts (47.8% vs. 52.2%) and hospitalizations in secondary hospitals (24.7% vs. 33.7%), and increased specialist palliative care ward (15.5% vs. 1.5%) and hospital-at-home (36.8% vs. 3.4%) utilization during the final month (P