Who receives specialist palliative care in Western Australia--and who misses out.

OBJECTIVES To describe the characteristics of Western Australian (WA) people who received, and did not receive, specialist palliative care (SPC) during their last 12 months of life. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS People who died between 1 July 2000 and 31 December 2002 in WA, and whose cause of death was from cancer or selected non-cancer conditions. MAIN OUTCOME MEASURES Use of SPC in the last 12 months of life. RESULTS There were 27,971 deaths from all causes in WA over the study period. Two-thirds (68%) of people who died of cancer received SPC, but less than one in ten (8%) who died of selected non-cancer conditions received SPC. Those who died of cancer were significantly less likely to receive SPC if they were single or widowed, aged > 85 years or lived in a region other than a major city. Of those who died of selected noncancer conditions, people other than those who were married were significantly less likely to have accessed SPC. Indigenous people were less likely to have accessed SPC, although this was not statistically significant (OR = 0.70, 95% CI: 0.36-1.34). CONCLUSIONS Within a WA context, this study confirms established international evidence for problems of access to SPC by non-cancer patients and other disadvantaged groups. Importantly, this evidence is provided at a population level, thus documenting the extent of inequities in palliative care service provision. By pointing to the areas of most critical need, this study assists in health service policy and planning.