[A Retrospective Study on the Current Status of Adjustment of Transition to the Place of Care for Patients with Terminal Cancer and Factors Leading to the Discontinuation of Such Adjustment].

Abstract

Background: Transitioning patients with cancer to end-of-life care settings poses psychological and operational challenges for patients, families, medical personnel, and collaborating medical institutions. However, such transitions may not always occur due to patient's deteriorating condition or death. Predicting the feasibility of these transitions is crucial for effective use of medical resources and effectuating end-of-life wishes. However, there are no reports examining the factors contributing to the discontinuation of adjustment.

Methods: We conducted a retrospective analysis of 235 patients with terminal cancer at our hospital, assessing estimated prognosis, preferred place of care, number of days of MSW intervention, number of days survived post-intervention, and completion/discontinuation of adjustment. Medical social workers(hereafter, MSW)facilitated patient transitions in FY2021. We calculated odds ratios associated with adjustment discontinuation and estimated prognosis.

Results: On average, patients received 22.9 days of intervention. Those patients completing the transition spent an average of 20.3 days at home and 28.6 days in a facility(p<0.001), with home adjustment being significantly shorter. Patients with estimated prognosis of less than 1 month were 7.1 times more likely to adjustment discontinuation than those with an estimated prognosis of 1 month or more.

Conclusion: Patients with estimated prognosis of less than 1 month were less likely to complete the adjustment. Considering the psychological and operational challenges for patients, families, and medical personnel, end-of-life care in cancer treatment hospitals must be considered. More information on the factors leading to the discontinuation of adjustments is expected to be accumulated in the future.