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Original Research: CRITICAL CARE MEDICINE |

Determinants of ICU Care in the Last Month of Life for Taiwanese Cancer Decedents, 2001 to 2006

Shiao-Chi Wu, PhD; Jen-Shi Chen, MD; Hung-Ming Wang, MD; Yen-Ni Hung, PhD; Tsang-Wu Liu, MD; Siew Tzuh Tang, DNSc
Author and Funding Information

From the Institute of Health and Welfare Policy (Drs Wu and Hung), National Yang-Ming University; Division of Hematology-Oncology (Drs Chen and Wang), Chang Gung Memorial Hospital, Chang Gung University College of Medicine; National Institute of Cancer Research (Dr Liu), National Health Research Institutes; School of Nursing (Dr Tang), Chan Gung University, and Nursing Department (Dr Tang), Chang Gung Memorial Hospital, Kaohsiung Branch, Kwei-Shan Tao-Yuan, Taiwan, Republic of China.

Correspondence to: Siew Tzuh Tang, DNSc, Chang Gung University, School of Nursing, 259 Wen-Hwa 1st Rd, Kwei-Shan Tao-Yuan, Taiwan 333, ROC; e-mail: sttang@mail.cgu.edu.tw


Funding/Support: This study was supported by a grant from the Bureau of Health Promotion, Department of Health, Taiwan, ROC (DOH96-HP-1510), with partial support from National Health Research Institutes (NHRI-EX99-9906PI).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1071-1077. doi:10.1378/chest.09-2662
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Background:  Use of the hospital ICU is rising rapidly for end-of-life care. The purpose of this population-based study was to determine the prevalence of ICU care in the last month of life of patients with cancer and the associations between ICU care and patient demographics, disease characteristics, physician specialty, hospital characteristics, and availability of health-care resources at the hospital and regional levels in Taiwan.

Methods:  This retrospective cohort study used administrative data for 204,850 cancer decedents from 2001 to 2006.

Results:  Rates of hospital ICU care in the last month of life did not change significantly from 2001 to 2006 (11.27%-12.71%). ICU use in the last month of life was more likely for single male patients aged < 65 years who had hematologic malignancies or esophageal cancer and more comorbidities or a nononcologist as primary-care physician. Patients with cancer were one-third less likely to use ICU care in their last month of life if they received care in a private hospital than if they were cared for in a public hospital. Patient propensity to receive ICU care in the last month of life was positively associated with increasing quartile of total hospital beds in their primary hospital’s region.

Conclusions:  Slightly more than one-tenth of Taiwanese patients with cancer received ICU care in their last month of life. ICU use was strongly influenced by receiving care in hospitals and regions with abundant health-care resources. Resources should be devoted to ensure that ICU care at the end of life best meets patients’ individual needs and interests.

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