Survival patterns of patients enrolled into Island Hospice Service palliative care programme

Abstract

Introduction and Background: Palliative care services aim to attain the best quality of life of patients. However, the lack of information on the survival of patients under palliative care has resulted in the implementation and assessment of care models being focused on reach without much consideration of the quality of care and the quality of life of patients in the context of survival. Amongst the few studies undertaken elsewhere, the target groups and settings to which the findings are inferable to are distinct to the Zimbabwean scenario. This study’s main aim was, therefore, to determine the survival of patients after enrolment into Island Hospice Service (IHS), a Zimbabwean palliative care programme established as the first hospice in Africa. Methodology: The study took the form of a Retrospective Cohort Design with data obtained from a computerized database at IHS. A total of 597 patients enrolled in the programme between 01/01/06 and 31/12/07 were included in the study and were retrospectively followed up with respect to mortality from their respective dates of enrolment to the study end-date of 31/12/08. Observations were censored on the study end-date and date of transfer or relocation. Results: This study found that the overall median survival of patients referred to the IHS palliative care programme is 419 days. This estimate is considerably higher than that found from other previous studies which range from 11 to 54 days. Patients diagnosed with HIV only were noted to have longer survival compared to those with Cancer only as well as those with both HIV and Cancer. The median survival estimates for patients with Cancer only and those with both Cancer and HIV were observed to be 84 days and 113 days respectively whilst that for those with HIV only was indeterminate. Some statistically significant differences in survival were also observed for study factors such as gender, age, source of referral and functional status but with variations under the specific disease groups. Conclusion: Patients enrolled in the IHS programme generally live longer relative to other palliative care programmes. The survival patterns of these patients are influenced by several factors, key among them being the disease status and functional status on enrolment. The study identified the need to incorporate survival data in care planning and modelling. Providing some awareness of the IHS Palliative Care programme to health professionals is also recommended as a possible strategy to improve the timing of referrals. This study also presents an opportunity for further epidemiological inquiry that may contribute to the organisation’s cancer prevention efforts.