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End-of-Life Cancer Care Resource Utilisation in Rural Versus Urban Settings: A Systematic Review

Author

Listed:
  • Jessica Cerni

    (School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia)

  • Joel Rhee

    (General Practice Academic Unit, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
    Illawarra Southern Practice Based Research Network (ISPRN), University of Wollongong, Wollongong, NSW 2522, Australia
    Centre for Positive Ageing + Care, HammondCare, Hammondville, NSW 2170, Australia)

  • Hassan Hosseinzadeh

    (School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia)

Abstract

Background: Despite the advances in End-of-life (EOL) cancer care, disparities remain in the accessibility and utilisation of EOL cancer care resources. Often explained by socio-demographic factors, geographic variation exists in the availability and provision of EOL cancer care services among EOL cancer decedents across urban versus rural settings. This systematic review aims to synthesise mortality follow-back studies on the patterns of EOL cancer care resource use for adults (>18 years) during end-of-life cancer care. Methods: Five databases were searched and data analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria involved; a) original research; b) quantitative studies; c) English language; d) palliative care related service use in adults (>18 years) with any malignancy excluding non-melanoma skin cancers; e) exclusive end of life focus; f) urban-rural focus. Narrative reviews and discussions were excluded. Results: 24 studies met the inclusion criteria. End-of-life cancer care service utilisation patterns varied by rurality and treatment intent. Rurality was strongly associated with higher rates of Emergency Department (ED) visits and hospitalisations and lower rates of hospice care. The largest inequities between urban and rural health service utilisation patterns were explained by individual level factors including age, gender, proximity to service and survival time from cancer diagnosis. Conclusions: Rurality is an important predictor for poorer outcomes in end-of-life cancer care. Findings suggest that addressing the disparities in the urban-rural continuum is critical for efficient and equitable palliative cancer care. Further research is needed to understand barriers to service access and usage to achieve optimal EOL care for all cancer patient populations.

Suggested Citation

  • Jessica Cerni & Joel Rhee & Hassan Hosseinzadeh, 2020. "End-of-Life Cancer Care Resource Utilisation in Rural Versus Urban Settings: A Systematic Review," IJERPH, MDPI, vol. 17(14), pages 1-15, July.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:14:p:4955-:d:382596
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    References listed on IDEAS

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    1. Hart, L.G. & Larson, E.H. & Lishner, D.M., 2005. "Rural definitions for health policy and research," American Journal of Public Health, American Public Health Association, vol. 95(7), pages 1149-1155.
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    Cited by:

    1. Doris Y. P. Leung & Helen Y. L. Chan, 2020. "Palliative and End-of-Life Care: More Work is Required," IJERPH, MDPI, vol. 17(20), pages 1-7, October.
    2. Camilla Jøhnk & Helene Holm Laigaard & Andreas Kristian Pedersen & Eithne Hayes Bauer & Frans Brandt & Georg Bollig & Donna Lykke Wolff, 2022. "Time to End-of-Life of Patients Starting Specialised Palliative Care in Denmark: A Descriptive Register-Based Cohort Study," IJERPH, MDPI, vol. 19(20), pages 1-11, October.
    3. Rachel Anne Rowntree & Hassan Hosseinzadeh, 2022. "Lung Cancer and Self-Management Interventions: A Systematic Review of Randomised Controlled Trials," IJERPH, MDPI, vol. 19(1), pages 1-26, January.

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