Hospice Use and Aggressive End-of-Life Care Among Cancer and Non-Cancer Decedents in Taiwan.

Abstract

Context: Palliative care has expanded to include non-cancer populations, yet disparities in hospice access and end-of-life (EOL) care quality between cancer and non-cancer patients remain.

Objectives: To examine 10-year trends and determinants of hospice use and aggressive EOL care among cancer and hospice-eligible non-cancer decedents in Taiwan.

Methods: This retrospective study included 15,546 adult inpatients who died or were terminally discharged from a tertiary center between 2010 and 2019. Patients were classified as cancer or hospice-eligible non-cancer based on Taiwan's National Health Insurance criteria. Hospice enrollment and 15 indicators of aggressive EOL care were assessed within the last 28 days of life. Linear and logistic regression identified trends and predictors.

Results: Hospice utilization increased significantly over time in both cancer and non-cancer groups. For cancer decedents, hospice enrollment rose from 6.2% in 2010 to 52.3% in 2019 (β = 0.94, p<0.001) while non-cancer patients showed a more modest increase from 0.6% to 16.2% (β = 0.81, p<0.001). Non-cancer patients consistently exhibited higher aggressive-care scores (mean 5.2 vs. 3.6, p<0.001), particularly in ICU admission, mechanical ventilation, vasopressor use, and CPR. Cancer diagnosis (aOR = 0.33), receipt of hospice care (aOR = 0.46), and self-signed DNR (aOR = 0.41) were independently associated with lower odds of receiving high-intensity EOL care.

Conclusions: Despite improvement, non-cancer patients remain less likely to access hospice and more likely to receive aggressive treatments. Enhanced prognostic recognition and equitable palliative integration are needed.