Effectiveness of two types of palliative home care in cancer and non-cancer patients: A retrospective population-based study using claims data

SAGE Palliative Medicine & Chronic Care

This episode features Dr Markus Krause (Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany) and Dr Antje Freytag (Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany). Palliative homecare is an important component of palliative care, and it has a positive impact on the quality of care at the end-of-life. The effect of different types of palliative homecare on quality of care is sparsely researched. Within palliative homecare, cancer patients still outweigh non-cancer patients. We compared two types of palliative homecare in Germany: primary palliative care and specialized palliative homecare. Both reduced potentially aggressive interventions at the end-of-life. The more comprehensive specialized palliative homecare was associated with less potentially aggressive interventions in terms of lower rates of hospital as the place of death, hospital care, intensive care treatment, chemotherapy, and application of a percutaneous endoscopic gastrostomy (PEG) within the last days of life. These results hold equally for cancer patients as well as non-cancer patients. Only for parenteral nutrition, we found a possible indication of oversupply in cancer patients (excepting those with gastrointestinal cancer) within specialized palliative homecare. The potential of palliative homecare, particularly of specialized palliative homecare, to reduce potentially aggressive interventions at the end-of-life deserves more attention in healthcare and health politics. Future studies should investigate which elements of specialized palliative homecare are effective and can be integrated into primary palliative care, where appropriate.