Variations in Prescribing of Subcutaneous End-of-Life Symptom Management Medications Among Home Care Recipients

Abstract

Background: Medications are often recommended for symptom control at the end of life (EOL). The objectives of this thesis are to assess the prescribing of subcutaneous symptom management medications during the last six weeks of life among home care recipients and the association of prescribing with various EOL outcomes. Methodology: A retrospective cohort study of home care decedents (2017-2020) in Ontario using ICES data. Results: Of 55,903 decedents, 28.6% received 1+ EOL symptom management prescription. Those with a prescription had a decreased risk of dying in an institution (risk ratio (RR): 0.59, 95% confidence interval (CI): 0.57-0.60), having an emergency department visit (RR: 0.22, 95% CI: 0.20-0.24) or hospitalization (RR: 0.20, 95% CI: 0.18-0.22) in the last two weeks of life. Conclusion: EOL prescribing is associated with a decreased risk of acute care use and death in an institutional setting among home care decedents.