title: Determinants of Hospital Death for Taiwanese Pediatric Cancer Decedents, 2001-2010.
abstract: BACKGROUND
  Factors influencing pediatric cancer patients' place of death may have evolved with advances in medical and hospice care since earlier studies were done.
  
  
  OBJECTIVE
  To comprehensively analyze factors associated with hospital death in an unbiased population of pediatric cancer patients in Taiwan.
  
  
  METHODS
  This was a retrospective cohort study using administrative data for 1603 Taiwanese pediatric cancer patients who died in 2001-2010. Place of death was hypothesized to be associated with 1) patient sociodemographics and disease characteristics, 2) primary physician's specialty, 3) characteristics and health care resources at both the hospital and regional levels, and 4) historical trends.
  
  
  RESULTS
  Most Taiwanese pediatric cancer patients (87.4%) died in an acute care hospital. The probability of dying in hospital increased slightly over time, reaching significance only in 2009 (adjusted odds ratio [AOR], 95% CI: 2.84 [1.32-6.11]). Children were more likely to die in an acute care hospital if they resided in the most urbanized area, were diagnosed with leukemia or lymphoma (2.32 [1.39-3.87]), and received care from a pediatrician (1.58 [1.01-2.47]) in a nonprofit proprietary hospital (1.50 [1.01-2.24]) or large hospital, reaching significance for the third quartile (2.57 [1.28-5.18]) of acute care hospital beds.
  
  
  CONCLUSIONS
  Taiwanese pediatric cancer patients predominantly died in an acute care hospital with a slightly increasing trend of shifting place of death from home to hospital. Propensity for hospital death was determined by residential urbanization level, diagnosis, primary physician's specialty, and the primary hospital's characteristics and health care resources. Clinical interventions and health policies should ensure that resources are allocated to allow pediatric cancer patients to die in the place they and their parents prefer to achieve a good death and promote their parents' bereavement adjustment.
authors.affiliation: School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China.
authors.forename: Yen-Ni
authors.initials: YN
authors.lastname: Hung
authors.affiliation: National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan, Republic of China.
authors.forename: Tsang-Wu
authors.initials: TW
authors.lastname: Liu
authors.affiliation: School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, Republic of China. Electronic address: sttang@mail.cgu.edu.tw.
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy; D011336:Probability; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D014505:Urban Population
keywords: Child; cancer death; hospital death; pediatric end-of-life care; place of death