Identification in administrative databases of women dying of breast cancer.
OBJECTIVE
Palliative care is an essential component of cancer care, and population-based research is needed to monitor its impact. Administrative databases are the cornerstone of health services research. Their limitation is that cause of death is not sufficient to readily classify decedents as terminally ill for the study of the health services they received at the end of life. The study purpose is to develop and test the validity of an algorithm allowing the classification of the decedents as dying of breast cancer (BC), using administrative data.


METHODS
Validation was carried out through a chart review of 119 BC decedents extracted from hospital-based databases. This algorithm was applied to 3,384 deceased women with BC representative of the whole population. The effect of the classification by the algorithm was illustrated by the shift in the distributions of age and place of death.


RESULTS
The validation showed a sensitivity of 95%, a specificity of 89%, a positive predictive value of 98%, and negative predictive value of 77% for the classification of women dying of BC. Of the 3,384 decedents, 2,293 were classified as dying of, and 1,091 as not dying of BC. Women dying of BC were younger, died less often at home (6.9% v 17.9%), and in chronic care institutions (4.1% v 14.8%), and more often in acute-care beds (69.9% v 57.1%).


CONCLUSIONS
This novel way to classify decedents is conceptually based and empirically validated through chart review and impact on distribution of age and place of death.
Division of Stroke, Rehabilitation, Health Care Services, McGill University, Montréal, Quebéc, Canada. bruno.gagnon@clinepi.mcgill.ca
Bruno
B
Gagnon
Nancy E
NE
Mayo
Carroll
C
Laurin
James A
JA
Hanley
Neil
N
McDonald
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001943:Breast Neoplasms / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D017051:Hospice Care; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D010166:Palliative Care; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013727:Terminal Care