title: Aggressive end-of-life care significantly influenced propensity for hospice enrollment within the last three days of life for Taiwanese cancer decedents.
abstract: BACKGROUND
  Late hospice enrollment exacts a substantial toll from patients, families, hospices, and society. The relationship between the propensity for late hospice enrollment and aggressive health services received at the end of life (EOL) has been underinvestigated.
  
  
  OBJECTIVE
  To identify determinants of hospice enrollment within the last three days of life.
  
  
  METHODS
  Retrospective population-based cohort study using administrative data for 31,529 Taiwanese cancer decedents who used hospice care in their last year of life.
  
  
  RESULTS
  Rates of hospice enrollment within the last three days of life (16.80%-18.73%) remained constant over 2001-2006. After adjustment for patient demographics and disease characteristics, physician specialty, availability of health care resources at the hospital and regional levels, and historical trends, late hospice enrollment was more likely if Taiwanese cancer patients received chemotherapy, had multiple emergency room visits or hospital admissions, and used the intensive care unit in their last month of life (adjusted odds ratio [95% confidence interval] (AOR [95% CI]): 1.61 [1.44-1.80], 1.40 [1.29-1.52], 1.78 [1.51-2.09], and 1.45 [1.19-1.76], respectively). Late hospice enrollment was less likely for patients with hospital stays>14 days or who received cardiopulmonary resuscitation in their last month of life (AOR [95% CI]: 0.51 [0.45-0.58] and 0.41 [0.25-0.65], respectively).
  
  
  CONCLUSIONS
  Aggressive EOL care played a more significant role than patient, physician, or hospital characteristics in determining the propensity of Taiwanese cancer patients to be enrolled in hospice care within their last three days of life. Clinical and health policies should aim to avoid aggressive care when it will not benefit patients but may preclude timely hospice enrollment.
authors.affiliation: Graduate School of Nursing, Chang Gung University, Taoyuan, Taiwan, Republic of China.
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
authors.affiliation: Department of Information Management, National Taipei College of Nursing, Taipei, Taiwan, Republic of China.
authors.forename: Ean-Wen
authors.initials: EW
authors.lastname: Huang
authors.affiliation: National Institute of Cancer Research, National Health Research Institutes, Taipei, Taiwan, Republic of China.
authors.forename: Tsang-Wu
authors.initials: TW
authors.lastname: Liu
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China; Division of Hematology-Oncology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China; Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Medical Foundation, Kaohsiung, Taiwan, Republic of China.
authors.forename: Kun-Ming
authors.initials: KM
authors.lastname: Rau
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China; Division of Hematology-Oncology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
authors.forename: Jen-Shi
authors.initials: JS
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000451:nursing*; D010343:Patient Admission / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D013727:Terminal Care / Q000706:statistics & numerical data*; D014600:Utilization Review; D055815:Young Adult