Annals of medicine · 2026
Disparities in hospice enrollment timing and end-of-life care intensity across non-cancer diagnoses: a 10-year hospital-based cohort study.
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Wang Chun-Li, Lee Lung-Chun, Hsu Chiann-Yi, Lin Chia-Yen
Аннотация
INTRODUCTION: Non-cancer patients with advanced illnesses often experience delayed hospice referral and high-intensity care near the end of life, yet cross-diagnosis comparisons remain limited. This study examined diagnosis-specific patterns in hospice use and care intensity among non-cancer decedents.
MATERIALS AND METHODS: We conducted a 10-year retrospective cohort study of adults with hospice-eligible non-cancer diagnoses who died or were discharged in a moribund condition between 2010 and 2019 at a tertiary referral hospital in Taiwan. Primary outcomes were place of death and an aggressive-care score (0-5) based on five EOL indicators in the last 28 days: hospitalisation >14 days, ≥1 intensive care unit (ICU) admission, ≥1 emergency department (ED) visit, cardiopulmonary resuscitation (CPR), and intubation with mechanical ventilation. Multivariable logistic regression identified factors associated with high aggressive-care scores (≥4).
RESULTS: Among 5,127 non-cancer decedents, 7% received hospice care, with rates varying across diagnostic groups. Most hospice enrolments (60.2%) occurred within 7 days before death. Hospice recipients had lower median aggressive-care scores (2 vs. 3, p < 0.001) and lower ICU admissions (39.7% vs. 63.7%), ED visits (62.2% vs. 75.1%), CPR (1.7% vs. 10.1%), and mechanical ventilation (9.2% vs. 23.2%). Advanced heart disease (aOR 1.95) and end-stage renal disease (aOR 1.96) were associated with high aggressive-care scores, while hospice enrolment was associated with lower odds of such scores (aOR 0.46).
CONCLUSION: Hospice care among hospitalised non-cancer decedents was infrequent and often initiated in the final week across diagnoses. These findings highlight diagnostic differences in end-of-life care intensity and support referral strategies for earlier palliative care integration.
MATERIALS AND METHODS: We conducted a 10-year retrospective cohort study of adults with hospice-eligible non-cancer diagnoses who died or were discharged in a moribund condition between 2010 and 2019 at a tertiary referral hospital in Taiwan. Primary outcomes were place of death and an aggressive-care score (0-5) based on five EOL indicators in the last 28 days: hospitalisation >14 days, ≥1 intensive care unit (ICU) admission, ≥1 emergency department (ED) visit, cardiopulmonary resuscitation (CPR), and intubation with mechanical ventilation. Multivariable logistic regression identified factors associated with high aggressive-care scores (≥4).
RESULTS: Among 5,127 non-cancer decedents, 7% received hospice care, with rates varying across diagnostic groups. Most hospice enrolments (60.2%) occurred within 7 days before death. Hospice recipients had lower median aggressive-care scores (2 vs. 3, p < 0.001) and lower ICU admissions (39.7% vs. 63.7%), ED visits (62.2% vs. 75.1%), CPR (1.7% vs. 10.1%), and mechanical ventilation (9.2% vs. 23.2%). Advanced heart disease (aOR 1.95) and end-stage renal disease (aOR 1.96) were associated with high aggressive-care scores, while hospice enrolment was associated with lower odds of such scores (aOR 0.46).
CONCLUSION: Hospice care among hospitalised non-cancer decedents was infrequent and often initiated in the final week across diagnoses. These findings highlight diagnostic differences in end-of-life care intensity and support referral strategies for earlier palliative care integration.