Determinants of ICU care in the last month of life for Taiwanese cancer decedents, 2001 to 2006.
BACKGROUND
Use of the hospital ICU is rising rapidly for end-of-life care. The purpose of this population-based study was to determine the prevalence of ICU care in the last month of life of patients with cancer and the associations between ICU care and patient demographics, disease characteristics, physician specialty, hospital characteristics, and availability of health-care resources at the hospital and regional levels in Taiwan.


METHODS
This retrospective cohort study used administrative data for 204,850 cancer decedents from 2001 to 2006.


RESULTS
Rates of hospital ICU care in the last month of life did not change significantly from 2001 to 2006 (11.27%-12.71%). ICU use in the last month of life was more likely for single male patients aged < 65 years who had hematologic malignancies or esophageal cancer and more comorbidities or a nononcologist as primary-care physician. Patients with cancer were one-third less likely to use ICU care in their last month of life if they received care in a private hospital than if they were cared for in a public hospital. Patient propensity to receive ICU care in the last month of life was positively associated with increasing quartile of total hospital beds in their primary hospital's region.


CONCLUSIONS
Slightly more than one-tenth of Taiwanese patients with cancer received ICU care in their last month of life. ICU use was strongly influenced by receiving care in hospitals and regions with abundant health-care resources. Resources should be devoted to ensure that ICU care at the end of life best meets patients' individual needs and interests.
Wu
Shiao-Chi
SC
Institute of Health and Welfare Policy, National Yang-Ming University, Kwei-Shan Tao-Yuan, Taiwan, Republic of China.
Chen
Jen-Shi
JS
Wang
Hung-Ming
HM
Hung
Yen-Ni
YN
Liu
Tsang-Wu
TW
Tang
Siew Tzuh
ST
D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D013727:Terminal Care / Q000706:statistics & numerical data