Place of death for hospice-cared terminal patients with cancer: A nationwide retrospective study in Taiwan.
BACKGROUND
Hospice care has been part of the Taiwan health-care system for 20 years. Detailed information on the place of death for terminal cancer patients is lacking. Impending death discharge (IDD) is unique in Taiwan, and our study aims to compare IDD with in-hospice death among terminal cancer patients under hospice care.


METHODS
This retrospective study used claims data of decedents of cancer from the National Health Insurance Research Database of Taiwan from 2007 to 2010.


RESULTS
Of the 22,720 cancer decedents enrolled, 6316 had claims data marked with IDD and 16,404 with in-hospice death. Those with IDD were older; had a shorter hospice stay; and higher rates of gastrointestinal, peritoneal, and pulmonary cancers. The mean daily health-care expenditure was higher in those with IDD, however, the total expenditure of terminal hospice admission was lower than those dying in hospices. Patients who were treated at public hospitals had a higher rate of in-hospice death than those treated at private hospitals. Patients with IDD were positively correlated with increasing age and shorter hospice stay. Patients with IDD were positively correlated with private hospitals, especially religious corporation-based hospitals. Male sex, oropharyngeal cancer, bone/connective/breast cancers, and secondary/metastatic cancers were negatively correlated with IDD.


CONCLUSIONS
Patients with IDD have characteristics distinct from those dying in hospices. Advanced age and short hospice stays were common in those with IDD, and in-depth investigations were needed. As a unique predying process in Taiwan, relevant health-care issues regarding IDD are warranted for further investigations.
Division of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
Heng-Yi
HY
Lin
Division of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: sckang@ym.edu.tw.
Shih-Chao
SC
Kang
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medical Teaching and Research, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
Yu-Chun
YC
Chen
Division of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
Yin-Chieh
YC
Chang
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Vice Superintendent's Office, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
Wei-Shu
WS
Wang
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Superintendent's Office, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
Su-Shun
SS
Lo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010351:Patient Discharge; D012189:Retrospective Studies; D013624:Taiwan
hospices; length of stay; neoplasms; palliative care; patient discharge