A population-based study on the determinants of hospice utilization in the last year of life for Taiwanese cancer decedents, 2001-2006

Abstract

Background: No population-based studies conducted outside Western countries have identified determinants of hospice utilization for all ages and cancer groups.

Objective: To evaluate associations between hospice utilization in the last year of life and patient demographics, disease characteristics, physician specialty, hospital characteristics, and availability of healthcare resources at the hospital and regional levels in Taiwan.

Methods: Retrospective cohort study using administrative data among 204, 850 Taiwanese cancer decedents, 2001-2006.

Results: Rates of hospice utilization increased significantly (12.99-17.24%) over the study period. Hospice utilization was more likely for cancer patients who were female; over 65 years old; currently or formerly married; with ≤1 concurrent disease; diagnosed with breast cancer or cancer having a poorer prognosis; with distant metastasis, and longer illness duration (>2 months since diagnosis); receiving care in a teaching hospital or hospital with an inpatient-hospice unit; and receiving care in a region with greater density of inpatient-hospice beds. However, patients with hematological malignancies and esophageal cancer were less likely to use hospice care.

Conclusions: Despite the 1.33 times increase in hospice utilization among cancer patients who died from 2001 to 2006, only one in six Taiwanese cancer decedents used hospice care in their last year of life. Our findings regarding determinants of hospice utilization should be used by healthcare professionals and policy makers to guide the development of policies and interventions that facilitate prognosis disclosure and EOL care discussions between physicians and patients, especially younger patients, to help the transition from curative to palliative care.