Background: To enable patients with advanced cancer to spend their final days at home, palliative care support must be available at home around the clock. Objectives: To evaluate how the integration of paramedics into end-of-life care for cancer patients affects the utilization of the emergency department, the time spent at home, and places of death. Design: Retrospective cohort study. Setting/Subjects: Patients who died of cancer in 2016–2017 in North Karelia, Finland. Methods: Emergency department visits and time spent at home among patients with or without enrollment in the paramedics’ end-of-life care protocol were evaluated. Results: Of the 767 patients who died of cancer, 160 (21%) were included in the end-of-life care protocol. An emergency department visit during the last month of life was needed in 34% of patients with and 48% without the protocol ( p = 0.002). The mean number of emergency department visits for patients with and without the protocol was 0.47 and 0.75, respectively (RR 0.55 95% Cl: 0.47–0.67, p < 0.001 in Poisson regression analysis). During the last 30 days of life, patients in the protocol spent more time at home (median of 21 vs. 11 days, p < 0.001) and died more often at home (26% vs. 4%, p < 0.001). Conclusions: Including paramedics in the end-of-life care pathway is associated with decreased emergency department visits during the last month of life and increased time spent at home, including at the time of death. Therefore, this integration of paramedics seems to direct health care resources more beneficially while honoring most patients’ preference to stay at home.
Surakka et al. (Tue,) studied this question.
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