End-of-life care for nursing home residents dying from cancer in Nova Scotia, Canada, 2000-2003.
BACKGROUND
With our population aging, an increasing proportion of cancer deaths will occur in nursing homes, yet little is known about their end-of-life care. This paper identifies associations between residing in a nursing home and end-of-life palliative cancer care, controlling for demographic factors.


METHODS
For this population-based study, a data file was created by linking individual-level data from the Nova Scotia Cancer Centre Oncology Patient Information System, Vital Statistics, and the Halifax and Cape Breton Palliative Care Programs for all persons 65 years and over dying of cancer from 2000 to 2003. Multivariate logistic regression was used to compare nursing home residents to nonresidents.


RESULTS
Among the 7,587 subjects, 1,008 (13.3%) were nursing home residents. Nursing home residents were more likely to be female [adjusted odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.7], older (for > or = 90 vs 65-69 years OR 5.4, CI 4.1-7.0), rural (OR 1.5, CI 1.2-1.8), have only a death certificate cancer diagnosis (OR 4.2, CI 2.8-6.3), and die out of hospital (OR 8.5, CI 7.2-10.0). Nursing home residents were less likely to receive palliative radiation (OR 0.6, CI 0.4-0.7), medical oncology consultation (OR 0.2, CI 0.1-0.4), and palliative care program enrollment (Halifax OR 0.2, CI 0.2-0.3; Cape Breton OR 0.4, CI 0.3-0.7).


CONCLUSIONS
Demographic characteristics and end-of-life services differ between those residing and those not residing in nursing homes. These inequalities may or may not reflect inequities in access to quality end-of-life care.
O'Brien
Meaghan B
MB
School of Health Services Administration, Dalhousie University and Surveillance and Epidemiology Unit, Cancer Care Nova Scotia, 5599 Fenwick Street, Halifax, Nova Scotia B3H 1R2, Canada.
Johnston
Grace M
GM
Gao
Jun
J
Dewar
Ron
R
D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006699:Home Care Services / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D009674:Nova Scotia; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012648:Self Care / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000458:organization & administration* / Q000706:statistics & numerical data