Accessibility of palliative care for adults in Poland

The increasing number and survival time of cancer patients raise the number of persons referred to palliative care. More and more, palliative care is also provided to patients with non-oncological diseases. Limiting publicly funded services, as well as limited human and material resources, create queues for admission, and reduce the chances of admitting patients with short life expectancy. This study aimed to examine the accessibility to palliative care, length of stay, mortality and its forms, patient transfer, as well as death and rate of dropout from care while waiting for admission. Based on the data from the National Health Fund and collected from palliative care entities in Poland in 2018, palliative care covered a total of 94.9 thousand patients, including 61 thousand home care patients, 35.9 thousand in-patients, and 16.7 thousand outpatients. 47.8% of patients died during home care (1.3% on the first day of care). Mortality in in-patient entities was 75.8% (2.8% on the first day of care). Palliative home care lasted an average of 107 (median 54), and in-patient care 33.2 (median 13) days. A quarter of patients remained in home care for up to 17 days and in in-patient care for up to 5 days. One-sixth of eligible persons were not admitted to home care and 29.1% to in-patient care. Most of them died while in a queue. In summary, access to palliative care in the last days of life is insufficient. Actions to improve accessibility should include increasing and abolishing limitation of services, changing qualification rules, settling death care days, patient diversification, increasing outlays on the development of in-patient care entities, and providing beds for emergency care.