Ahtiluoto Satu E, Carpén Timo P, Forsius Pirita T, Nuutinen Mikko S J, Nåhls Nelli-Sofia A, Kitti Pauliina M, Hammar Teija H, Finne-Soveri Harriet U, Saarto Tiina H
Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
The Department of Healthcare and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
Eur J Public Health. 2025 May 28. doi: 10.1093/eurpub/ckaf044.
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.
非恶性疾病导致60%需要姑息治疗的非传染性疾病，但专科姑息治疗服务主要集中在癌症方面。我们调查了癌症患者和非恶性疾病患者临终时的医疗保健和社会服务利用情况，其次还调查了获得专科姑息治疗的情况及其对服务利用的影响。这项基于全国登记数据的回顾性研究纳入了2019年在芬兰死于非传染性、限制生命疾病的所有成年人（n = 38540），分为神经退行性疾病组（31%）、其他非恶性疾病组（36%）和癌症组（33%）。医院是最常见的死亡地点（61%）。在所有组中，临终前几周的医疗保健利用率大幅上升，但癌症患者的利用率仍然最高。神经退行性疾病患者的社会服务利用率最高。与神经退行性疾病（10.9%）和其他非恶性疾病（7%）相比，癌症患者（30.1%）与专科姑息治疗机构的接触显著更多（P < 0.001）。与晚期/未与专科姑息治疗机构接触相比，早期（死亡前>30天）接触显著减少了急诊接触（47.8%对52.2%）和二级医院住院率（24.7%对33.7%），并增加了最后一个月专科姑息治疗病房（15.5%对1.5%）和居家医院服务（36.8%对3.4%）的利用率（P < 0.001）。所有疾病组的医疗保健利用率都很高，癌症患者中最高。医院是最常见的死亡地点。非恶性疾病患者很少与专科姑息治疗机构接触。临终前一个月与专科姑息治疗机构的早期接触与较低的急诊利用率和二级医院住院护理相关。这些结果凸显了为所有人及时提供公平的专科姑息治疗服务的必要性。
