Differences in symptoms and problems experienced by patients with life threatening disease in specialized palliative care and basic palliative care- a nationwide cross-sectional study
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Background: Patients with life threatening disease often experience palliative care needs (symptoms and problems) before death and those with the most complex needs should be those who get access to specialized palliative care. To examine if that is the case, studies are needed comparing palliative care needs of patients with life-threatening cancer and non-cancer disease admitted to specialized palliative care to patients receiving basic palliative care. Aims: To compare palliative care needs among patients with life threatening disease admitted to specialized palliative care and patients receiving basic palliative care. Design: A secondary data analysis of symptoms/problems reported by patients in basic palliative care or at admittance to specialized palliative care in Denmark. Ordinal logistic regression was performed to study differences in the probability of experiencing each symptom/problem among patients receiving specialized vs. basic palliative care, controlled for possible confounders. Setting/participants: Patients with life-threatening disease who completed the EORTC QLQ-C15-PAL-questionnaire. Results: The study included 6,367 patients. The odds of experiencing symptoms, impaired physical functioning, impaired emotional functioning and poor quality of life, were higher at admittance to specialized palliative care compared to ongoing basic palliative care, especially impaired physical functioning (OR: 8.3, 95% CI: 6.6-10.5) and fatigue (OR: 5.1, 95% CI: 4.1-6.5). Conclusions: Patients in specialized palliative care had higher levels of symptoms and problems than patients with life threatening disease receiving basic palliative care, especially non-cancer patients. Future research should study changes in symptoms/problems during the disease trajectory among patients with life-threatening diseases to improve referral to specialized palliative care.
