Sex Disparities at the End-of-Life-Where do We Stand in Palliative Care? Experiences of a Specialist Palliative Care Unit in a High-Income Country.

ObjectivesPalliative care aims to improve the quality of life of people with life-threatening diseases. While this offer should address anyone in need regardless of their background, sex, and gender differences need to be considered to account for differences in symptom load and social disparities.MethodsWe conducted a retrospective analysis of 745 patients hospitalized at the Competence Center Palliative Care at the University Hospital Zurich, Switzerland, from 2019 to 2020. We examined sociodemographic and clinical factors, including symptom load, disease-related and end-of-life-related data extracted from the electronic patient record. These data were further analyzed for sex-specific differences. Statistical analyses were performed using IBM SPSS, version 31.0.ResultsWe report on 405 men and 340 women with a median age of 70 and 71 years, respectively, hospitalized on the palliative care ward with a median length of stay of >10 days for 48.6% of men and 53.2% of women, respectively. Most patients were admitted with cancer (78.7% of men, 77.1% of women). Prior to hospitalization, women were significantly more likely to live alone (P < .001) and to rely on support other than from a partner (P < .001) or homecare (P < .003), reflecting not only biological but also gender differences. While there was no difference in pain perception (P = .529), women experienced significantly more gastrointestinal symptoms than men (P < .001). Support offers did not differ between the sexes (P = .663). Both men and women were referred late in the disease trajectory, with a median of 18 days before death (CI 14.49-21.51).ConclusionsWe identified several differences between men and women regarding the experience and delivery of specialist palliative and end-of-life care. The need to optimize patient-centered end-of-life care with a clear focus on sex- and gender-specific differences remains an important task for the upcoming years and should occur early in the disease trajectory.