Determinants of Aggressive End-of-Life Care for Taiwanese Cancer Decedents, 2001 to 2006

Tang, Siew Tzuh; Wu, Shiao Chi; Hung, Yen Ni; Chen, Jen Shi; Huang, Ean Wen; Liu, Tsang Wu

doi:10.1200/jco.2008.20.5096

Cited by 108 publications

(106 citation statements)

References 39 publications

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“…A composite aggressive end-of-life care score has previously been reported, 10 with one point for each of the following 6 ASCO/NQF indicators in the last 30 days of life: two or more ER visits, two or more hospital admissions, more than 14 days of hospitalization, an ICU admission, death in a hospital, and use of chemotherapy. The total score ranged from 0 to 6, with a higher score indicating more aggressive care.…”

Section: Methodsmentioning

confidence: 99%

Quality of end‐of‐life care in patients with hematologic malignancies: A retrospective cohort study

Hui

Didwaniya

Vidal

et al. 2014

Cancer

263

255

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Background Limited data is available on the quality of end-of-life care for patients with hematologic malignancies. In this retrospective cohort study, we compared the quality of end-of-life care between patients with hematologic malignancies and those with solid tumors. Methods All adult patients who died of advanced cancer between 9/1/2009 and 2/28/2010 while under the care of our institution were included. We collected baseline demographics and end-of-life care indicators, including emergency room visits, hospitalization, intensive care unit admissions, and systemic cancer therapy use within the last 30 days of life. Results 113/816 (14%) decedents had hematologic malignancies. In the last 30 days of life, hematologic patients were more likely to have emergency room visits (54% vs. 43%, P=0.03), hospital admissions (81% vs. 47%, P<0.001), >=2 admissions (23% vs. 10%, P<0.001), >14 days of hospitalization (38% vs. 8%, P<0.001), intensive care unit admissions (39% vs. 8%, P<0.001) and death (33% vs. 4%, P<0.001), chemotherapy use (43% vs. 14%, P<0.001), and targeted therapy use (34% vs. 11%, P<0.001) compared to patients with solid tumors. Patients with hematologic malignancies were also less likely to have palliative care unit admissions (8% vs. 17%, P=0.02). The composite score for aggressiveness of care (0=best, 6=worst) was significantly higher among patients with hematologic malignancies than those with solid tumors (median 2 vs. 0, P<0.001). In multivariate analysis, hematologic malignancy was a significant factor associated with aggressive end-of-life care (odds ratio 6.6, 95% confidence interval 4.1–10.7, P<0.001). Conclusions Patients with hematologic malignancies received more aggressive care at the end-of-life.

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Section: Methodsmentioning

confidence: 99%

Quality of end‐of‐life care in patients with hematologic malignancies: A retrospective cohort study

Hui

Didwaniya

Vidal

et al. 2014

Cancer

263

255

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“…A number of previous studies have identified variation in patients with cancers' ED attendance based on differing sociodemographic (predisposing) factors. [16][17][18] Our findings, however, suggest that rather than these factors per se influencing patients' ED use, it is the variation in symptom perception among these groups that ultimately determines the overall differences seen. This mechanism of action is further supported by previous studies that have identified variation in symptom perception by patient sociodemographics, including differences found across social class 33 and ethnicity.…”

Section: Discussionmentioning

confidence: 59%

“…[16][17][18] While these studies have identified a number of sociodemographic, environmental and clinical risk factors (eg, sex, age, ethnicity, socioeconomic status and type of cancer), evidence for why people with cancer decide to attend the ED is limited. 19 20 In order to address this issue and help guide development of future healthcare services, we conducted the following qualitative study.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

‘I'll be in a safe place’: a qualitative study of the decisions taken by people with advanced cancer to seek emergency department care

et al. 2016

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ObjectiveTo explore the decisions of people with advanced cancer and their caregivers to seek emergency department (ED) care, and understand the issues that influence the decision-making process.DesignCross-sectional qualitative study incorporating semistructured patient and caregiver interviews.MethodsBetween December 2014 and July 2015, semistructured interviews were conducted with 18 people with advanced cancer, all of whom had recently attended the ED of a large university teaching hospital located in south-east London; and six of their caregivers. Interviews were audio recorded, transcribed verbatim and analysed using a constant comparative approach. Padgett and Brodsky's modified version of the ‘Behavioral Model of Health Services Use’ was used as a framework to guide the study.ResultsIssues influencing the decision-making process included: (1) disease-related anxiety—those with greater anxiety related to their cancer diagnosis interpreted their symptoms as more severe and/or requiring immediate attention; (2) prior patterns of health-seeking behaviour—at times of crisis participants defaulted to previously used services; (3) feelings of safety and familiarity with the hospital setting—many felt reassured by the presence of healthcare professionals and monitoring of their condition; and, (4) difficulties accessing community healthcare services—especially urgently and/or out-of-hours.ConclusionsThese data provide healthcare professionals and policymakers with a greater understanding of how systems of care may be developed to help reduce ED visits by people with advanced cancer. In particular, our findings suggest that the number of ED visits could be reduced with greater end-of-life symptom support and education, earlier collaboration between oncology and palliative care, and with increased access to community healthcare services.

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“…These indicators have been widely recognised and evaluated in several countries [5][6][7][8][9][10]. The most recent survey performed by Earle et al [6] involved 215,484 patients [65 years of age who died from cancer between 1991 and 2000 and who had been diagnosed while living in an area monitored by one of the Surveillance Epidemiology and End Results (SEER) registries.…”

Section: Therapeutic Aggressivenessmentioning

confidence: 99%

The limit of therapies in oncology

Nanni¹,

Scarpi²

2010

J Med Pers

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Determinants of Aggressive End-of-Life Care for Taiwanese Cancer Decedents, 2001 to 2006

Cited by 108 publications

References 39 publications

Quality of end‐of‐life care in patients with hematologic malignancies: A retrospective cohort study

Quality of end‐of‐life care in patients with hematologic malignancies: A retrospective cohort study

‘I'll be in a safe place’: a qualitative study of the decisions taken by people with advanced cancer to seek emergency department care

The limit of therapies in oncology

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