Palliative care for non-cancer conditions in primary care : a time trend analysis in the UK (2009-2014)

Objectives Whilst guidelines recommend palliative care in non-cancer conditions, this has not been widely implemented. We examined whether the recording of a palliative care approach and the numbers of hospital deaths for deceased patients with heart failure, dementia, chronic obstructive pulmonary disease (COPD) and cancer have changed since the UK End of Life Care Strategy was introduced. Methods We conducted sequential cross-sectional studies of decedents within the UK’s Clinical Practice Research Datalink and Hospital Episode Statistics. All adults with a primary care record of COPD (N=5,426), dementia (N=7,339), heart failure (N=6,409) or cancer (N=18,668) who died during three one-year periods (April 2009-March 2014) were included. Evidence of a palliative care approach was identified from primary care records, and death in hospital from secondary care data. Results From 2009 to 2014, proportions with a primary care record of palliative care increased for COPD from 13.6% to 21.2%; dementia from 20.9% to 40.7%; and heart failure from 12.6% to 21.2%; but remained substantially lower than for cancer (57.6% to 61.9%). Median days before death of recording improved for COPD (145 to 224) and dementia (44 to 209); but not for heart failure (168.5 to 153) and cancer (123 to 114). Trends in hospital deaths were not consistently downward, although the proportions of patients dying in hospital were lower in the last period compared to the first. Conclusions Recording of a palliative care approach for non-cancer conditions has increased since the introduction of the UK End of Life Care Strategy, but remains inadequate.