Hospice Care Improves Patients’ Self-Decision Making and Reduces Aggressiveness of End-of-Life Care for Advanced Cancer Patients

Chun-Li Wang, Chia-Yen Lin () and Shun-Fa Yang ()
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Chun-Li Wang: Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Chia-Yen Lin: Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Shun-Fa Yang: Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan

IJERPH, 2022, vol. 19, issue 23, 1-15

Abstract: The aim of the current study is to evaluate the different degrees of hospice care in improving patients’ autonomy in decision-making and reducing aggressiveness of cancer care in terminal-stage cancer patients, especially in reducing polypharmacy and excessive life-sustaining treatments. This was a retrospective cross-sectional study conducted in a single medical center in Taiwan. Patients with advanced cancer who died in 2010–2019 were included and classified into three subgroups: hospice ward admission, hospice shared care, and no hospice care involvement. In total, 8719 patients were enrolled, and 2097 (24.05%) admitted to hospice ward; 2107 (24.17%) received hospice shared care, and 4515 (51.78%) had no hospice care. Those admitted to hospice ward had significantly higher rates of having completed do-not-resuscitate order (100%, p < 0.001) and signed the do-not-resuscitate order by themselves (48.83%, p < 0.001), and they had lower aggressiveness of cancer care (2.2, p < 0.001) within the 28 days before death. Hospice ward admission, hospice shared care, and age > 79 years were negatively associated with aggressiveness of cancer care. In conclusion, our study showed that patients with end-of-life hospice care related to higher patient autonomy in decision-making and less excessively aggressive cancer care; the influence of care was more overt in patients approaching death. Further clinical efforts should be made to clarify the patient and the families’ satisfaction and perceptions of quality after hospice care involvement.

Keywords: aggressiveness of cancer care at the end of life (ACCEoL); autonomy; hospice care; do-not-resuscitate (DNR); terminal cancer (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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