title: What is the data-defined length for short time from diagnosis to death that is associated with a low rate of palliative care enrolment for persons with colorectal cancer?
abstract: OBJECTIVE
  Prior research has demonstrated that people who die shortly after receiving a cancer diagnosis are at increased risk for not being referred to palliative care. No previous studies have empirically derived the length of time between diagnosis and death associated with increased risk. The objective of this study was to identify the length of time between diagnosis and death associated with increased risk for non-enrolment in a palliative care programme.
  
  
  METHODS
  Binary recursive partitioning was employed to derive the cut-point for the number of days from colorectal cancer diagnosis to death predictive of a high risk for non-enrolment in a palliative care programme in two health districts in Nova Scotia, Canada. The study included all adults (≥20 years) who were diagnosed with colorectal cancer in the two districts between 1 January 2001 and 31 December 2005 and who died between 1 January 2001 and 31 December 2008 (n=894).
  
  
  RESULTS
  Individuals who died within 18.5 days following diagnosis were at highest risk for non-enrolment in palliative care. Of the 60 adults who died in <18.5 days, 16.7% were enrolled in a palliative care programme; of the 835 adults who died ≥18.5 days after diagnosis, 65.9% were enrolled.
  
  
  CONCLUSIONS
  This data-driven approach may be used to define the short diagnosis-to-death time frame at which individuals are at increased risk for non-enrolment in palliative care programmes. This approach allows researchers to further investigate and compare empirically-derived cut-points that identify those who die quickly and are at risk of not receiving palliative care.
authors.affiliation: Department of Performance Excellence, Capital District Health Authority, Halifax, Nova Scotia, Canada.
authors.forename: Sheri
authors.initials: S
authors.lastname: Roach
authors.affiliation: Department of Community Health & Epidemiology, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Steenbeek
authors.affiliation: Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdolell
authors.affiliation: Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Robin
authors.initials: R
authors.lastname: Urquhart
authors.affiliation: Faculty of Health Professions, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Grace
authors.initials: G
authors.lastname: Johnston
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002423:Cause of Death; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: Cancer; Prognosis; Supportive care