University of Oulu

Hirvonen, O.M., Leskelä, R., Grönholm, L. et al. The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study. BMC Palliat Care 19, 37 (2020).

The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death : a retrospective cohort study

Saved in:
Author: Hirvonen, Outi M.1; Leskelä, Riikka-Leena2; Grönholm, Lotta3;
Organizations: 1Department of Oncology and Radiotherapy, Turku University Hospital and Department of Clinical Oncology, University of Turku, PO Box 52, FI-20521, Turku, Finland
2Nordic Healthcare group, Helsinki, Finland
3Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, Helsinki University, Helsinki, Finland
4Tuusula Health Care Centre, Tuusula, Finland
5Center of Oncology, Kuopio University Hospital, Kuopio, Finland
6Department of Clinical Oncology, Oulu University Hospital, Oulu, Finland
7Department of Oncology, Palliative Care Unit, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: Springer Nature, 2020
Publish Date: 2020-05-04


Background: In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death.

Methods: A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 – Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death.

Results: A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (> 180 days prior to death 72% and < 14 days 10%). The number of ED visits and inpatient days were highest for patients with no PC decision and lowest for patients with both a PC decision and an PC unit appointment (60 days before death ED visits 1.3 vs 0.8 and inpatient days 9.9 vs 2.9 respectively, p < 0.01). Patients with no PC decision died more often in secondary/tertiary hospitals (28% vs. 19% with a PC decision, and 6% with a decision and an appointment to a PC unit).

Conclusions: The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.

see all

Series: BMC palliative care
ISSN: 1472-684X
ISSN-E: 1472-684X
ISSN-L: 1472-684X
Volume: 19
Issue: 1
Article number: 37
DOI: 10.1186/s12904-020-00547-8
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Funding: TS has received grants from the State Research Funding for Helsinki University Hospital [Y1018XTS15, Y1018XTS16], and TS and the study group from the Finnish Cancer Society [170114]. With the grants, OH and LG have carried out the data collection, and R-LL and SV performed the analyses, taken part in interpretation of the data as well as writing of the manuscript.
Copyright information: © The Author(s). 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.