Association of Hospice Care Services With the Utilization of Life-Sustaining Treatments During End-of-Life Care Among Patients With Cancer: A Nationwide 11-Year Cohort Study |
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| Authors: | Yung-Feng Yen Yun-Ju Lai Ming-Chung Ko Yu-Yen Chen Yi-Tui Chen Yi-Sheng Chou Chun-Teng Huang Chu-Chieh Chen |
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| Institution: | 1. Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan;2. Institute of Public Health, National Yang-Ming University, Taipei, Taiwan;3. Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan;4. Department of Education and Research, Taipei City Hospital, Taiwan;5. School of Medicine, National Yang-Ming University, Taipei, Taiwan;6. Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan;7. Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan;8. Department of Urology, Taipei City Hospital, Taipei, Taiwan;9. Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan;10. School of Medicine, Chung Shan Medical University, Taichung, Taiwan;11. Department of Hematology and Oncology, Taipei City Hospital, Renai Branch, Taipei, Taiwan;12. Department of Hematology and Oncology, Taipei City Hospital, Yang-Ming Branch, Taipei, Taiwan;1. Netherlands Institute of Health Services Research (Nivel), Utrecht, The Netherlands;2. V&VN Dutch Nurses Association, Utrecht, The Netherlands;3. Amsterdam UMC, VU Amsterdam, Public Health Research Institute (APH), Amsterdam, The Netherlands;4. Expertise Center for Palliative Care Amsterdam, Amsterdam UMC, VU Medical Center Amsterdam, Amsterdam, The Netherlands;1. Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA;2. Albany Medical College, Albany, New York, USA;3. Department of Gynecologic Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA;1. Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou, China;2. Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China;3. The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China;4. China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia;5. School of Science, RMIT University, Melbourne, Australia;1. Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA;2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA |
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| Abstract: | ContextThe impact of hospice care services on the utilization of life-sustaining treatments during end-of-life care in terminally ill patients has not been extensively studied.ObjectivesTo determine the impact of hospice care services on the utilization of life-sustaining treatments during the last three months of life among patients with cancer.MethodsThis nationwide population-based cohort study identified adults with cancer diagnosis from the Taiwan Registry for Catastrophic Illness, 2006–2016. Life-sustaining treatments included cardiopulmonary resuscitation, intubation, mechanical ventilation support, nasogastric tube feeding, and total parenteral nutrition. Hospice care services consisted of hospice inpatient care, hospice-shared care, and hospice home care. The association of hospice care services with the utilization of life-sustaining treatments was determined using multiple logistic regression.ResultsOf 516,409 patients with cancer, 310,722 (60.2%) patients used life-sustaining treatments during the last three months of life. After adjusting for covariates, patients with hospice care services were less likely to receive life-sustaining treatments during the last three months of life than those without the services (adjusted odds ratio AOR]: 0.70; 95% CI: 0.69–0.71). While type of life-sustaining treatments were considered, hospice care services were associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR: 0.125; 95% CI: 0.118–0.131), endotracheal intubation (AOR: 0.204; 95% CI: 0.199–0.210), mechanical ventilation support (AOR: 0.265; 95% CI: 0.260–0.270), nasogastric tube feeding (AOR: 0.736; 95% CI: 0.727–0.744), and total parenteral nutrition (AOR: 0.86; 95% CI: 0.84–0.88).ConclusionHospice care services were associated with a lower likelihood of receiving life-sustaining treatments during the last three months of life in patients with cancer. |
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| Keywords: | Cancer patients hospice care life-sustaining treatments cohort study |
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