Start of the COVID-19 pandemic and palliative care unit utilization: a retrospective cohort study.

CONTEXT: People with non-cancer diagnoses have poorer access to palliative care units (PCUs) or hospices compared to those with cancer diagnoses. The COVID-19 pandemic disrupted how specialist palliative care services were delivered and utilized.

OBJECTIVE: To determine the association between the start of the COVID-19 pandemic and PCU/hospice utilization in hospitalized individuals with cancer and non-cancer diagnoses with specialist palliative care needs.

METHODS: Retrospective cohort study using routinely collected data. Percentages of individuals experiencing each disposition from hospital, including discharge to PCU/hospice, were calculated monthly for the total, cancer, and non-cancer cohorts and were analyzed descriptively. Hospitalized individuals with specialist palliative care needs at a single academic hospital in Toronto, Canada from January 1, 2017, to September 31, 2022 (pandemic start was defined as April 1, 2020).

RESULTS: The cohort comprised 4,349 individuals (median age=78 years; 52.4% female); 3,065 (70.5%) and 1,284 (29.5%) had cancer and non-cancer diagnoses, respectively. Among individuals with non-cancer diagnoses, the most significant absolute changes were a 13.0%-decrease in in-hospital deaths (pre-pandemic=49.6%; post-pandemic=36.6%) and a 11.6%-increase in discharges to PCU/hospice (pre-pandemic=35.6%; post-pandemic=47.3%). Among individuals with cancer, the most significant absolute changes were a 12.8%-increase in discharges home with formal care (pre-pandemic=2.3%; post-pandemic=15.1%) and a 7.0%-decrease in in-hospital deaths (pre-pandemic=29.1%; post-pandemic=22.0%).

CONCLUSION: Despite historically poor PCU/hospice access, the COVID-19 pandemic created circumstances that may have enabled unprecedented utilization in individuals with non-cancer diagnoses in our cohort. This substantiates that so long as it is concordant with their goals, individuals with non-cancer diagnoses can have enhanced PCU/hospice utilization.