AI Article Synopsis
- The study investigates the best timing to start palliative care for terminal cancer patients to enhance quality of care and reduce costs, as traditional definitions were based on study protocols rather than actual patient experiences.
- Researchers analyzed a nationwide database, comparing two patient groups (hospice-shared care vs. usual care) using statistical models to assess differences in quality of care and medical expenses.
- Results showed that starting hospice care 8-60 days before death improved quality of care, while initiating it 15-90 days prior led to significantly lower medical costs.
Article Abstract
Purpose: The existing concept suggests early palliative and hospice therapy for a better quality of care (QOC) and less medical expense in terminal cancer patients, but the time points of "early" initiation were defined by pre-set study protocol rather than the real-world data. The study aimed to determine the optimal timing of initiating palliative care for patients with terminal cancer.
Methods: This retrospective population-based study was conducted using a nationwide database. We extracted patients with cancer who were in their last year of lives in the period from 1 January 2010 to 31 December 2013 and categorized them into two groups ("hospice-shared care" (HSC) group and "usual care" (UC) group) after a matching process. Subsequently, we used a generalized linear mixed-effects model to compare the QOC and medical expenses between groups.
Results: After the selection and matching process, we enrolled 1714 patients (67.7 ± 13.2 years, 62.7% male) categorized into the HSC and UC groups (n = 857 in each group). The HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8-60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15-90 days before death.
Conclusions: Among patients with terminal cancer, HSC initiation before the last 8 days and 15 days of lives can effectively improve QOC and save medical expenses, respectively.
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| http://dx.doi.org/10.1007/s00520-021-06284-9 | DOI Listing |
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