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Chen CC, Lien HY, Tsai CY, Woung LC, Ko MC. Differences in End-of-Life Care Between Patients Who Died of Cancer Diseases and Those Who Died of Noncancer Diseases. J Palliat Med 2024. [PMID: 39023051 DOI: 10.1089/jpm.2023.0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Background and Purpose: Patients with advanced noncancer diseases or advanced cancer diseases may experience similar symptom burdens during the end of their lives. This study aimed to evaluate the differences in receiving hospice care service and in receiving aggressive end-of-life care between patients who died of cancer diseases and those who died of noncancer diseases. Methods: This cross-sectional population-based study used data from the Taiwan National Health Insurance Research Database. Subjects who died of cancers or noncancer diseases from 2010 through 2019 were analyzed to identify the information on patient's characteristics, receipt of hospice care service, receipt of cardiopulmonary resuscitation (CPR) during the last hospitalization, and receipt of airway support interventions during the last hospitalization. The independent effects of various characteristics on the receipt of hospice care, CPR during the last hospitalization, and airway support interventions during the last hospitalization were evaluated using multivariate logistic regressions. Results: A total of 587,490 patients were included, of which 434,142 died of cancers and 153,348 died of noncancer diseases. There were significant trends of increase in receiving hospice care service and significant trends of decrease in receiving CPR or airway support interventions during the last hospitalization in both patients who died of cancers and those who died of noncancer diseases. Compared with patients who died of cancers, those who died of noncancer diseases were less likely to receive hospice care service (adjusted odds ratio [AOR]: 0.087; 95% confidence interval [CI]: 0.085-0.089) and had a higher risk of receiving CPR (AOR: 3.610; 95% CI: 3.521-3.704) or airway support interventions during the last hospitalization (AOR: 3.086; 95% CI: 3.021-3.165). Conclusions: Hospice care service should be promoted for all patients with end-stage diseases especially those with noncancer diseases.
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Affiliation(s)
- Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Hsin-Yi Lien
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
- Taipei City Hospital, Taipei City, Taiwan
| | - Ching-Yao Tsai
- Taipei City Hospital, Taipei City, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Lin-Chung Woung
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
- Taipei City Hospital, Taipei City, Taiwan
| | - Ming-Chung Ko
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
- Taipei City Hospital, Taipei City, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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Syrnioti G, Eden CM, Johnson JA, Alston C, Syrnioti A, Newman LA. Social Determinants of Cancer Disparities. Ann Surg Oncol 2023; 30:8094-8104. [PMID: 37723358 DOI: 10.1245/s10434-023-14200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/09/2023] [Indexed: 09/20/2023]
Abstract
Cancer is a major public health issue that is associated with significant morbidity and mortality across the globe. At its root, cancer represents a genetic aberration, but socioeconomic, environmental, and geographic factors contribute to different cancer outcomes for selected population subsets. The disparities in the delivery of healthcare affect all aspects of cancer management from early prevention to end-of-life care. In an effort to address the inequality in the delivery of healthcare among socioeconomically disadvantaged populations, the World Health Organization defined social determinants of health (SDOH) as conditions in which people are born, live, work, and age. These factors play a significant role in the disproportionate cancer burden among different population groups. SDOH are associated with disparities in risk factor burden, screening modalities, diagnostic testing, treatment options, and quality of life of patients with cancer. The purpose of this article is to describe a more holistic and integrated approach to patients with cancer and address the disparities that are derived from their socioeconomic background.
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Affiliation(s)
- Georgia Syrnioti
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA.
- Department of Surgery, One Brooklyn Health-Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.
| | - Claire M Eden
- Department of Surgery New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA
| | - Josh A Johnson
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Chase Alston
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Antonia Syrnioti
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Lisa A Newman
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
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Kimani CW, Kioko UM, Ndinda C, Adebayo PW. Factors Influencing Progressive Utilization of Palliative Care Services among Cancer Patients in Kenya: The Case of Nairobi Hospice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6871. [PMID: 37835141 PMCID: PMC10572499 DOI: 10.3390/ijerph20196871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/15/2023] [Accepted: 08/31/2023] [Indexed: 10/15/2023]
Abstract
The rising cases of non-communicable diseases, specifically cancer, have led to the integration of palliative care in their management. However, only 10% of cancer patients have access to palliative care. Healthcare utilization is an important step in disease management as it aids individuals in accessing opportunities for the prevention and treatment of diseases. The study applied the binary probit model to estimate the progressive utilization of palliative care services by cancer patients. The aim of the study was to determine factors influencing the progressive utilization of palliative care by cancer patients. A cross-sectional data survey was conducted for 169 cancer patients seeking palliative care at the Nairobi Hospice in 2013. For each patient, the predisposing, enabling, and need (PEN) factors were analyzed as key criteria for applying progressive utilization of palliative care at the Nairobi Hospice as compared to those residing in other counties in the study. Descriptive statistics showed that 27% of patients studied resided in Nairobi County, where 61% were female, 62% were married, 35% had primary education, 44% were self-employed, and 59% had medical insurance. Probit regression and marginal effects showed that employment and religion were significant in determining the progressive utilization of palliative care. Employment status and religion are consequently the main factors that both governments and health-focused non-governmental organizations need to consider increasing the probability of progressively utilizing palliative care to improve the quality of life of cancer patients.
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Affiliation(s)
- Caroline Wambui Kimani
- School of Economics, Population and Development Studies, University of Nairobi, Nairobi Campus, Nairobi, Kenya; (C.W.K.)
| | - Urbanus Mutuku Kioko
- School of Economics, Population and Development Studies, University of Nairobi, Nairobi Campus, Nairobi, Kenya; (C.W.K.)
| | - Catherine Ndinda
- Human Sciences Research Council, Pretoria 0001, South Africa
- Development Studies, University of South Africa, Pretoria 0002, South Africa
| | - Pauline Wambui Adebayo
- School of Built Environment & Development Studies, University of Kwazulu-Natal, Durban 4041, South Africa
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Shepard V, Al Snih S, Burke R, Downer B, Kuo YF, Malagaris I, Raji M. Characteristics Associated With Mexican-American Hospice Use: Retrospective Cohort Study Using the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE). Am J Hosp Palliat Care 2023; 40:480-491. [PMID: 35731552 PMCID: PMC9772355 DOI: 10.1177/10499091221110125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hospice use is lower among ethnic/racial minorities in the United States, though little is known about trends, associated factors and duration of hospice use by Mexican-Americans. AIM The purpose of this study is to examine Mexican-American characteristics associated with hospice stay, both ≤ and > 7 days. DESIGN This retrospective cohort study used data from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) and the Centers for Medicare and Medicaid Services. Multivariate logistic regression models were used to estimate the ORs and 95% CIs for hospice stay among Mexican-Americans, both ≤ and > 7 days. SETTING AND PARTICIPANTS The first cohort (N = 970) includes H-EPESE participants who died between 2004 and 2016 who had Medicare parts A and B. The second cohort (N = 403) includes participants who completed the H-EPESE survey within the last 2 years of life. RESULTS Although hospice use increased among Mexican-Americans between 2004 and 2016 (OR 1.88, 95% CI 1.19-2.97), 38% of participants died within the first week of hospice care. Mexican-Americans in New Mexico and Arizona were 2-4 times more likely to use hospice than those in Texas and Colorado. Dementia was associated with hospice use (OR 1.47, 95% CI 1.11-1.94). Characteristics, like church attendance and living alone, were not associated with hospice use. CONCLUSIONS The substantial proportion of Mexican-Americans with 7 days or less of hospice use underscores the need for early palliative/hospice intervention to mitigate variation in use.
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Affiliation(s)
- Victoria Shepard
- Department of Population Health, University of Texas Dell Medical School, Austin, TX, USA
| | - Soham Al Snih
- Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, TX, USA
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Department of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Rebecca Burke
- Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, TX, USA
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, TX, USA
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Ioannis Malagaris
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila Raji
- Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, TX, USA
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Meng X, An Z, Xu Y, Du J, Tan L, Yu H, Yu L. Living experiences of people with advance cancer with low socioeconomic status: A systematic review of qualitative evidence. Palliat Med 2022; 37:444-459. [PMID: 36411513 DOI: 10.1177/02692163221137106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The number of patients with advanced cancer is rapidly increasing, and the subgroup of this population with low socioeconomic status has suffered more disease burden than others. However, there is no recent qualitative synthesis of primary research studies into advanced cancer patients with low socioeconomic status. OBJECTIVE To synthesise qualitative research findings into advanced cancer patients' experiences with low socioeconomic status, and then to help provide targeted and effective strategies to improve their quality of life. DESIGN A systematic review and meta-synthesis of qualitative evidence (PROSPERO: CRD42021250423). DATA SOURCES PubMed, Web of Science Core Collection (ISI Web of Science), Cochrane Library, Embase, OVID LWW, CINAHL Complete (EBSCO), PsycINFO (EBSCO) and MEDLINE (ISI Web of Science), China National Knowledge Infrastructure (CNKI), WangFang, and Vip databases were systematically searched from their original dates to July 2022. Qualitative data were appraised using the Joanna Briggs Institute (JBI) qualitative assessment. FINDINGS The findings were synthesised into the following three analytical themes: (1) multi-dimensional disease distresses; (2) barriers in coping with disease distresses; and (3) strategies for dealing with disease distresses. CONCLUSIONS Patients with advanced cancer with low socioeconomic status experienced complicated and interactional distresses, unique life barriers, and a wide range of adaptation strategies. These findings will provide a comprehensive perspective to promote individual-centred health care systems and services to help these vulnerable people deal with the challenges of disease and improve their quality of life.
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Affiliation(s)
- Xianmei Meng
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Zifen An
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Yuying Xu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Jiayi Du
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Lanhui Tan
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Huidan Yu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Liping Yu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
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Chuang MH, Lee FN, Shiau YT, Shen HY, Lee CC, Chen SSS, Huang SJ. Physician Palliative Education Associated With High Use of Hospice Care Service. Am J Hosp Palliat Care 2021; 39:237-242. [PMID: 33960206 PMCID: PMC8793295 DOI: 10.1177/10499091211014160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Taiwan’s National Health Insurance provides coverage for palliative and hospice care. The following 10 types of diseases have been added to the National Health Insurance reimbursement regulation: end-stage cancer, motor neuron disease, organic psychosis, brain degeneration, heart failure, chronic airway obstruction diseases, other lung diseases, chronic liver disease and cirrhosis, acute renal failure, and chronic renal failure. Objective: This study aimed to determine the association between physicians’ palliative education and use of hospice care in hospitalized patients at the end of life. Design and Setting: A cross-sectional study in a Taipei community hospital. Participants: Patients who died between 2014 and 2019 were identified. The deceased had at least 1 of the 10 diseases covered by health insurance were included. Hospice care services included hospice ward care and hospice shared care. This study included 2,661 individuals. In total, 972 (36.5%) patients used hospice care services. Results: After adjusting for age, gender, and comorbidities, physicians’ palliative education was found to significantly associated with the use of hospice care (OR: 14.38, 95% CI: 10.90-18.98). Conclusions: Physicians’ palliative education was found to be an independent factor associated with higher use of hospice care. The findings suggest increasing palliative and hospice education among physicians so that they can ensure that their patients have high-quality end-of-life medical care in an aging society.
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Affiliation(s)
- Mei-Hsing Chuang
- Division of Family Medicine, 205690Taipei City Hospital Zhong Xiao Branch, Taipei.,Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei
| | - Fang-Niarn Lee
- Department of Internal Medicine, 205690Taipei City Hospital Zhong Xiao Branch, Taipei
| | - Yih-Tsong Shiau
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital Zhong Xiao Branch, Taipei
| | - Hsiu-Yi Shen
- Department of Nursing, 38010Taipei City Hospital Zhong Xiao Branch, Taipei
| | - Chih-Ching Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital Zhong Xiao Branch, Taipei.,Division of Palliative Medicine, 38010Taipei City Hospital Zhong Xiao Branch, Taipei
| | - Saint Shiou-Sheng Chen
- Division of Urology, 38010Taipei City Hospital Zhong Xiao Branch, Taipei.,Department of Urology, National Yang-Ming University School of Medicine, Taipei.,Commission for General Education, College of Applied Science, National Taiwan University of Science and Technology, Taipei.,University of Taipei, General Education Center, Taipei
| | - Sheng-Jean Huang
- Superintendent Office & Division of Neurosurgery, Department of Surgery, 38010Taipei City Hospital, Taipei.,Department of Surgery, College of Medicine, National Taiwan University, Taipei
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