Bridging policy and practice: Determinants of place of death for palliative care recipients in Taiwan.

PURPOSE: Given the impact of place of death (PoD) on end-of-life quality and policy planning, this study examined the distribution and determinants of PoD among older adults receiving palliative care in Taiwan, with a focus on service models and referral-to-death intervals.

METHODS

This population-based study analyzed linked data from the Health and Welfare Data Science Center in Taiwan for 177,403 decedents aged ≥ 65 years who received palliative care and died between 2010 and 2020. Multivariable logistic regression was employed to examine associations between PoD and individual characteristics, hospital attributes, palliative care models, and referral-to-death intervals.

RESULTS

Hospital was the most common PoD (61.5%), followed by home (35.8%). Home death was more likely among females (OR 1.08, 95% CI 1.05-1.10), those aged 75-79 years (OR 1.29, 95% CI 1.25-1.34), cancer decedents (OR 1.40, 95% CI 1.36-1.45), and those receiving palliative care in private hospitals (OR 1.31, 95% CI 1.28-1.34). Use of home palliative care (OR 3.93, 95% CI 3.71-4.16) or home care combined with shared-care services during admission (OR 3.89, 95% CI 3.72-4.06) was strongly associated with home death. Referrals longer than 180 days were associated with a lower likelihood of hospital death (OR 0.84, 95% CI 0.79-0.90).

CONCLUSION

Among older palliative care recipients, early referral and access to home-based and shared-care services play a significant role in promoting home death. Optimizing end-of-life care may require integrating these elements into palliative care policy and service planning.