Which cancer patients are referred to hospital at home for palliative care?

Previous research has shown that palliative home care use is influenced by variables such as age, socioeconomic status, presence of an informal carer, diagnosis, and care dependency. However, there is little information on its association with other health service use. This study compared 121 cancer patients referred to Hospital at Home (HAH) for palliative care with a sample of 206 cancer patients not referred who died within the same period. Electronic record linkage of NHS databases enabled investigation of patients' total input of care in their last year of life. Univariate analysis showed that patients referred to HAH were younger, lived in less deprived areas, were less likely to have been diagnosed within a month of death and to have causes other than cancer recorded on their death certificate. They were furthermore more likely to have had specialist oncology input, Macmillan nursing, Marie Curie nursing, acute hospital care, and district nursing before their last month of life. When care was received, patients referred to HAH received more hours of district nursing care. However, patients not referred to HAH began their acute hospital and district nursing input earlier (further from death) than those referred. Multivariate logistic regression analysis showed HAH referral to be negatively associated with breast and genitourinary cancers and number of noncancer causes recorded on the death certificate. Referral was significantly positively associated with specialist oncology input, Marie Curie nursing, and a late start (close to death) of acute hospital and district nursing care. It is hypothesised that referral to palliative home care is more likely among patients who have had prior contact with cancer services or are most clearly identified as cancer patients, and whose illness progression is manifested by a relatively short but intensive period of care prior to death.