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. 2023 Nov 6;11(21):2907.
doi: 10.3390/healthcare11212907.

Effectiveness of Palliative Care before Death in Reducing Emergency Care Utilization for Patients with Terminal Cancer and Trends in the Utilization of Palliative Care from 2005-2018

Yi-Shiun Tsai  1   2 , Wen-Chen Tsai  2 , Li-Ting Chiu  2 , Pei-Tseng Kung  3   4
Affiliations

Effectiveness of Palliative Care before Death in Reducing Emergency Care Utilization for Patients with Terminal Cancer and Trends in the Utilization of Palliative Care from 2005-2018

Yi-Shiun Tsai et al. Healthcare (Basel). .

Abstract

This retrospective cohort study aimed to examine the effect of palliative care for patients with terminal cancer on healthcare utilization. The National Health Insurance (NHI) Research Database and death certificates were utilized to identify patients who died of cancer between 2005 and 2018. The number of terminal cancer patients between 2005 and 2018 was 605,126. Propensity score matching and conditional logistic regression were performed. The odds ratios (ORs) for "emergency care utilization", "CPR", "endotracheal intubation", and "ICU admission" were significantly lower for enrolled patients regardless of enrollment time compared to unenrolled patients. Compared to unenrolled patients, the OR for "emergency care utilization" increased from 0.34 to 0.68, the OR for "CPR use" increased from 0.13 to 0.26, the OR for "intubation" increased from 0.15 to 0.26, and the OR for "ICU admission" increased from 0.27 to 0.40 in enrolled patients. Between 2005 and 2010, CPR utilization, intubation, and ICU admission in patients enrolled in palliative care declined each year. Since the inclusion of palliative care in NHI (from 2010 onward), its utilization has increased slightly each year. Patients with terminal cancer enrolled in palliative care consume fewer medical resources before death than unenrolled patients; however, the difference decreases with longer times before death.

Keywords: CPR (cardiopulmonary resuscitation); ICU (intensive care unit) admission; emergency care utilization; endotracheal intubation; palliative care; terminal cancer patients.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the selection process.
Figure 2
Figure 2
Trends in the percentage of terminal cancer patients enrolled in palliative care before death, 2005–2018.
Figure 3
Figure 3
The historical trend in the ratio of emergency department utilization among terminal cancer patients whether in palliative care or not between 2005 and 2018 and the ratio of emergency department utilization rates for those enrolled to those not enrolled in terminal cancer patients at 1, 4, 8, 12, and 24 weeks before death.
Figure 4
Figure 4
The historical trend in the ratio of cardiopulmonary resuscitation among terminal cancer patients depending on whether they were in palliative care or not between 2005 and 2018 and the ratio of cardiopulmonary resuscitation utilization rates for those enrolled to those not enrolled in terminal cancer patients at 1, 4, 8, 12, and 24 weeks before death.
Figure 5
Figure 5
The historical trend in the ratio of endotracheal intubation utilization among terminal cancer patients depending on whether they were in palliative care or not between 2005 and 2018 and the ratio of endotracheal intubation utilization rates for those enrolled to those not enrolled in terminal cancer patients at 1, 4, 8, 12, and 24 weeks before death.
Figure 6
Figure 6
The historical trend in the ratio of ICU admission among terminal cancer patients depending on whether they were in palliative care or not between 2005 and 2018 and the ratio of ICU admission utilization rates for those enrolled to those not enrolled in terminal cancer patients at 1, 4, 8, 12, and 24 weeks before death.
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