Background: Little is known about the role of geographic access to inpatient palliative and end of life care (PEoLC) facilities in place of death and how geographic access varies by settlement (urban and rural). This study aims to fill this evidence gap. Methods: Individual-level death data in 2014 (N = 430,467, aged 25 +) were extracted from the Office for National Statistics (ONS) death registry and linked to the ONS postcode directory file to derive settlement of the deceased. Drive times from patients' place of residence to nearest inpatient PEoLC facilities were used as a proxy estimate of geographic access. A modified Poisson regression was used to examine the association between geographic access to PEoLC facilities and place of death, adjusting for patients' socio-demographic and clinical characteristics. Two models were developed to evaluate the association between geographic access to inpatient PEoLC facilities and place of death. Model 1 compared access to hospice, for hospice deaths versus home deaths, and Model 2 compared access to hospitals, for hospital deaths versus home deaths. The magnitude of association was measured using adjusted prevalence ratios (APRs). Results: We found an inverse association between drive time to hospice and hospice deaths (Model 1), with a dose-response relationship. Patients who lived more than 10 min away from inpatient PEoLC facilities in rural areas (Model 1: APR range 0.49-0.80; Model 2: APR range 0.79-0.98) and urban areas (Model 1: APR range 0.50-0.83; Model 2: APR range 0.98-0.99) were less likely to die there, compared to those who lived closer (i.e. ≤ 10 min drive time). The effects were larger in rural areas compared to urban areas. Conclusion: Geographic access to inpatient PEoLC facilities is associated with where people die, with a stronger association seen for patients who lived in rural areas. The findings highlight the need for the formulation of end of life care policies/strategies that consider differences in settlements types. Findings should feed into local end of life policies and strategies of both developed and developing countries to improve equity in health care delivery for those approaching the end of life.
Bibliographical noteFunding Information:
The Guide_Care Services project is a large scale observational study investigating the role of service factors in place of death funded by the National Institute for Health Research, Health Services and Delivery Research Programme (NIHR HS&DR, 14/19/22), led by Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation at King’s College London, UK. It is a follow-on project to the Guide_Care project (NIHR HS&DR, 14/19/22) (NIHR HS&DR, 14/19/22). We thank all collaborators and advisors including service-users. Investigators: Wei Gao (co-PI), Irene J Higginson (co-PI), Julia Verne, Emma Gordon and Giovanna Polato. Project Advisory Group members: Tony Bonser, Nicola Bowtell, Kate Heaps, Jamie Jenkins, Katie Lindsey, Catherine Millington-Sanders, Rajive Mitra, Myfanwy Morgan, Carolyn Morris, Robert Mulliss, Andy Pring, Sarah Russell, Jane Smith, Claire Henry, Claudia Wells, Paula Young. Researchers: Emeka Chukwusa (Project Manager), Peihan Yu, Rebecca Wilson, Clare Pearson, Sumaya Huque. Administrative support: Halle Johnson, Daniel Gulliford, Sophie Watson, Zaynah Sheikh. We thank the data providers for this work: Office for National Statistics (ONS), the Health and Social Care Information Centre (HSCIC), Care Quality Commission (CQC), the National Council for Palliative Care (NCPC), the London Cancer Alliance (LCA), Ordnance Survey data—© Crown Copyright and Database Right 2016. Ordnance Survey (Digimap License).
The National Institute for Health Research, Health Services and Delivery Research Programme Guide_Care Services project (NIHR HS & DR, 14/19/22). This project is partly supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London at King’s College Hospital NHS Foundation Trust, and Cicely Saunders International. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
© 2019 The Author(s).
- Geographic accessibility
- Inpatient palliative and end of life care (PEoLC) facilities
- Place of death