title: Comfort in the last 2 weeks of life: relationship to accessing palliative care services.
abstract: BACKGROUND
  Specialised palliative care services (SPCS) aim to address the needs of patients and caregivers confronting life-limiting illnesses but only half of the potential cohort are referred. Randomised controlled trials of SPCS provision can no longer be ethically justified so there is a need to develop new methods to evaluate the net impact of SPCS for the whole community, not just for those who access SPCS. The aim of this study was to assess whether perceived comfort in the last 2 weeks of life was associated with accessing SPCS.
  
  
  METHODS
  This study utilised a whole-of-population random survey (n = 4,366) in South Australia. A total of 802 respondents had someone close to them die within the last 5 years due to a terminal illness, and they had the complete data. A subsequent question was asked whether SPCS had been accessed. Perceived comfort levels for those who had used SPCS were compared with those who did not by using stereotype logistic regression, weighted to a standardised population.
  
  
  RESULTS
  Higher levels of comfort of the deceased having been assessed 'very comfortable' was associated with the use of SPCS (p = 0.04; odds ratio, 1.78; 95% confidence interval, 1.02-3.08). For people who accessed SPCS, 13.3% were reported as 'very comfortable' compared with 8.0% without SPCS. Almost one half of respondents (48.4%) reported that the deceased was considered 'uncomfortable' or 'very uncomfortable', irrespective of SPCS access.
  
  
  CONCLUSIONS
  While this study provides further incremental evidence of benefit from access to SPCS, there is much that still needs to be done to improve care for the whole community at the end of life.
authors.affiliation: Department of Palliative and Supportive Services, Flinders University, Daw Park, Adelaide, South Australia. david.currow@rgh.sa.gov.au
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Ward
authors.forename: John L
authors.initials: JL
authors.lastname: Plummer
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
mesh_terms: D000223:Adaptation, Psychological; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010166:Palliative Care / Q000379:methods*; D010865:Pilot Projects; D011787:Quality of Health Care; D013021:South Australia; D011795:Surveys and Questionnaires