Cancer patients have a reduced likelihood of dying in hospital with advance care planning in primary health care and a summarizing palliative plan: a prospective controlled non-randomized intervention trial

Figures & data

Figure 1. Flow diagram for inclusion and exclusion.

Table 1. Patient characteristics.

	with ACP and palliative plan			Controls
Patient characteristics	N=			N=			p
Age, mean years (SD)	75	71.5	(10.2)	69	67.9	(8.4)	0.024^a
Sex	75			69			0.672^b
Female		30	40.0 %		30	43.5 %
Male		45	60.0 %		39	56.5 %
Educational level	69			50			0.444^c
Lower than high school		27	39.1 %		14	28.0 %
High school		26	37.7 %		23	46.0 %
University		16	21.8 %		13	26.0 %
Living together with partner	75			51			0.933^d
Yes		52	69.3 %		35	68.6 %
No		23	30.7 %		16	31.4 %
Estimated survival time	75			69			<0.001^e
Between one and 6 months		30	40.0 %		2	2.9 %
Between 6 and 12 months		23	30.7 %		11	15.9 %
More than one year		18	24.0 %		13	18.8 %
Between one and 5 years		4	5.3 %		43	62.3 %
Karnofsky PS inclusion, mean score (SD)	75	74.2	(12.8)	69	88.0	(8.3)	< 0.001^f
Karnofsky PS last follow up, mean score (SD)	73	47.1	(18.7)	68	50.4	(22.8)	0.345^g
QoL 1–7 inclusion, mean score	71	4.5		52	5.0		0.033^h
QoL 1–7 last follow up, mean score	49	4.5		46	4.5		0.282^i
GP home visits	75			69			< 0.001^j
Yes		58	77.3 %		25	28.1 %
No		17	22.7 %		44	71.0 %
Contact with PC team	75			69			< 0.001^k
Yes		73	97.3 %		52	75.4 %
No		2	2.7 %		17	24.6 %
Days from inclusion to death	67	233	(231.6)	61	468	(500.5)	< 0.001^l

^aIndependent two-sided t-test for differences in Age (t(142) = –2.28, p = 0.024, 95% CI (–0.710 to –0.050)).

^bPearson’s chi-square test for differences in sex (X² (1, n = 144) = 0.179; p = 0.672).

^cPearson’s chi-square test for differences in educational level (X² (2, n = 119) = 1.624; p = 0.444).

^dPearson’s chi-square test for differences in living with partner yes/no (X² (1, n = 126) = 0.007; p = 0.933).

^ePearson’s chi-square test for differences in estimated survival time at inclusion (X² (3, n = 144) = 61.76; p < 0.001).

^fIndependent two-sided t-test for differences in the Karnowsky index at inclusion (t(142) = 7.56, p < 0.001, 95% CI (0.902–1.618)).

^gIndependent two-sided t-test for differences in Karnowsky index at last follow up (t(142) = 0.95, p = 0.345, 95% CI (–0.171 to 0.490)).

^hPearson’s chi-square test for differences in QoL 1–7 at inclusion (X² (6, n = 123) = 13.68; p = 0.033).

ⁱPearson’s chi-square test for differences in QoL 1–7 at last follow up (X² (5, n = 95) = 6.25; p = 0.282).

^jPearson’s chi-square test for GP home visits, yes or no (X² (1, n = 144) = 24.86; p < 0.001).

^kPearson’s chi-square test for contact with hospital-based PC team, yes or no (X² (1, n = 144) = 15.14; p < 0.001).

^lIndependent two-sided t-test for differences in days from inclusion to death (t(126) = 3.46, p < 0.001, 95% CI (0.256–0.965)).

Table 2. Place of care last 90 days of life and place of death.

	with ACP and palliative plan			Controls
Place of care and death	N=			N=			p
Place of care last 90 days of life	67			61
Home, mean days (SD)		62.4	(25.3)		64.5	(26.8)	0.641^m
Nursing home, mean days (SD)		16.0	(24.0)		11.0	(24.0)	0.239^n
Hospital, mean days (SD)		11.6	(10.9)		14.4	(14.1)	0.201^o
Place of death	67			61			0.033^p
Home		20	29.9 %		18	29.5 %
Nursing home		35	52.2 %		22	36.1 %
Hospital		12	17.9 %		21	34.4 %
Hospital admissions last 90 days	67			61			0.320^q
Mean admissions (SD)		2.00	(1.46)		2.26	(1.51)

^mIndependent two-sided t-test for differences in days at home (t(126) = 0.468, p = 0.641, 95% CI (–0.264 to 0.430)).

ⁿIndependent two-sided t-test for differences in days at nursing home (t(126) = –1.182, p = 0.239, 95% CI (–0.557 to 0.139)).

^oIndependent two-sided t-test for differences in days in hospital (t(126) = 1.285, p = 0.201, 95% CI (–0.121 to 0.575)).

^pPearson’s chi-square test for differences in dying in primary health care (home/nursing home) or hospital (X² (1, n = 128) = 4.55; p = 0.033).

^qIndependent two-sided t-test for differences in hospital admissions (t(126) = 0.998, p = 0.320, 95% CI (–0.170 to 0.524)).

Figure 2. Place of death with and without ACP conversation in primary health care and a summarizing palliative plan, p = 0.033 for death in hospital.