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

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 = 38 540) 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 < .001) higher in cancer (30.1%) compared to neurodegenerative (10.9%) and other non-malignant (7%) diseases. Early (>30 days 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 < .001). Healthcare utilization was high in all disease groups, highest among cancer patients. Hospital was the most common place of death. Specialist palliative care contact was rare in non-malignant diseases. Early contact with specialist palliative care associated with lower emergency care utilization and secondary hospital inpatient care during the last month of life. These results highlight the necessity for timely equitable specialist palliative care services for all.