3.3 Does Geography Play a Role in the Receipt of End-of-Life Care for Advanced Cancer Patients? Evidence from an Australian Local Health District Population-Based Study

Article Overview

Title: Does Geography Play a Role in the Receipt of End-of-Life Care for Advanced Cancer Patients?Authors: Jessica Cerni, Hassan Hosseinzadeh, Judy Mullan, Victoria Westley-Wise, Lorraine Chantrill, Greg Barclay, Joel Rhee

Abstract

Objectives: This study aims to assess the impact of geographic remoteness on healthcare utilization patterns for end-of-life (EOL) cancer patients within an Australian health district, highlighting disparities faced by rural populations.

Methods: This retrospective cohort study examined the healthcare behaviors of 3546 cancer patients aged 18 and older who died in a public hospital between 2015 and 2019. The study utilized various metrics for rurality and travel times to measure access to EOL services.

Results:

• Emergency and Inpatient Care: Rural decedents exhibited a higher frequency of emergency department visits juxtaposed with significantly lower rates of hospital admissions and access to specialized palliative care and outpatient services compared to their metropolitan counterparts.

• Palliative Care Utilization: Notably, shorter travel times correlated with more consistent utilization of inpatient specialist palliative care services, suggesting that distance is a critical factor influencing care access.

Conclusions: This research identifies geographic variations in EOL care utilization, emphasizing the urgent need for policy changes to enhance accessibility to EOL care services in rural regions of Australia.

Keywords

cancer, end of life, geography, health services research, palliative care, rural, travel time

Introduction

High-quality EOL care for patients with advanced cancer is of paramount importance. Existing disparities in the access to EOL care, particularly for individuals in rural settings, are stark and troubling. Addressing these urban-rural inequities in healthcare is vital, especially considering that a significant proportion of the Australian population resides outside major cities, where healthcare access often remains fragmented and inadequate.

Methods

Study Design and Setting:

• Type: Retrospective, population-based cohort study aimed at providing a comprehensive view of healthcare usage patterns.

• Location: Conducted in a diverse health district serving over 400,000 residents, allowing for a multidimensional analysis of healthcare access and utilization.

Data Sources: Administrative health data linked to individual health service records, allowing for robust analysis of service access.

Measures:

• Analyzed the use of both inpatient and outpatient health services accessed in the last 12 months of patients' lives.

• Count adjusted per 10,000 population to allow for meaningful comparisons across different demographic groups.

Geographic Remoteness Metrics:

• Employed the Modified Monash Model (MMM) and travel-time estimations to assess remoteness and access levels.

• Categories used include metropolitan areas, regional centers, and a range of rural town classifications (large, medium, small).

Statistical Analyses:

• Chi-square tests and logistic regression were utilized to analyze associations between healthcare service usage and geographic remoteness, providing clarity on underlying trends.

Results

Patient Demographics:

• The majority of participants were male (60.1%), aged 65 and older, and married (56.9%). Most exhibited high Charlson Comorbidity Index values, indicating significant underlying health issues.

Inpatient Services Utilization:

• Acute Care: Rural patients had notably high rates of emergency visits which conflicted with significantly lower rates of inpatient treatment, raising questions about care adequacy and accessibility in rural settings.

• Palliative Care Services: While nearly all patients received at least one palliative care admission, the use of specialist palliative care was significantly lower in rural areas, highlighting a systemic issues affecting care delivery.

Outpatient Services Utilization:

• There were lower rates of outpatient chemotherapy and radiotherapy among rural patients; however, some rural areas demonstrated increased rates of outpatient cancer services, indicating potential pockets of effective care.

Discussion

Geographic disparities fundamentally influence the quality and quantity of EOL care delivered to patients. Mixed findings regarding hospitalization rates highlight the variability in access to healthcare resources based on regional differences. This necessitates focused attention and policy strategies aimed at improving access to both inpatient palliative care and outpatient services in rural regions.

Policy Implications

The study concludes with recommendations for health policy to address these disparities. Suggested interventions include redistributing EOL resources to better serve rural populations and alleviate travel burdens that hinder access to essential healthcare services.

Conclusion

Geographic remoteness is a critical factor that influences the accessibility and utilization of EOL care services. Targeted research is called for to better understand the gaps in regional healthcare disparities, so that informed improvements can be enacted.

Authors’ Contributions

All authors contributed collaboratively to the design, analysis, and drafting of the study and the article, ensuring a comprehensive examination of healthcare variability based on geographic factors.

Acknowledgments

The authors acknowledge the generous support and resources provided by the Centre for Health Research Illawarra Shoalhaven Population throughout the course of this research.

References

A comprehensive array of citations is included to anchor the findings of this research within existing scholarly literature, emphasizing the efficacy and reliability of the study's conclusions.