Factors associated with dying in hospital awaiting palliative care admission: a retrospective cohort study

BACKGROUND: Palliative care facilities, including palliative care units (PCUs), remain underutilized with individuals dying in hospital despite having applied for admission. Historically, lower proportions of individuals with non-cancer diagnoses versus cancer diagnoses access these facilities. The study was conducted to determine the sociodemographic, functional, and clinical factors associated with dying in hospital awaiting PCU admission. METHODS: This was a retrospective cohort study using routinely collected data from a clinical database supplemented with data from a chart review in a randomly selected subgroup. The cohort included individuals hospitalized at a single hospital in Toronto, Canada awaiting PCU admission between January and December 2023. Logistic regression was used to determine factors associated with dying in hospital awaiting PCU admission. RESULTS: In the total cohort (N = 426; median age = 78 years, 52% female), a minority had a non-cancer diagnosis (32%) and an expected prognosis of hours to days (18%). Most (87%) were admitted to the PCU. The subgroup (N = 133) had similar characteristics to the total cohort. Regression analysis in the total cohort showed that dying in hospital awaiting PCU admission was associated with a prognosis of hours to days (OR = 7.42; 95% CI = 1.87-29.42) but not with having a non-cancer diagnosis, after adjusting for sociodemographic, functional, and clinical factors. Regression analysis in the subgroup showed no significant association between dying in hospital awaiting PCU admission and being followed by a palliative care specialist or having a documented goals of care discussion before the terminal admission. CONCLUSIONS: In hospitalized individuals awaiting PCU admission, only a very short prognosis was associated with dying in hospital. Despite historical evidence of poor access, a non-cancer diagnosis was not associated with dying in hospital awaiting PCU admission.