Hospice preference of the family decision-makers for cancer patients in China: an exploratory study

Mortality from malignant neoplasms at home and in hospitals in Brazil, 2002-2022: sociodemographic characteristics and temporal trends

OBJECTIVE

To analyze the sociodemographic characteristics and temporal trends of deaths due to malignant neoplasms in Brazil, according to whether they occurred at home or in a hospital, from 2002 to 2022.

METHODS

This is a descriptive and ecological study analyzing data on cancer deaths from the Brazilian Mortality Information System. The analysis included descriptive measures, mortality rates, and trends based on joinpoint regression of sociodemographic variables, according to the place of death, as well as associations with the occurrence at home or in hospitals.

RESULTS

We analyzed a total of 3,696,553 cancer deaths in Brazil, of which 82.5% occurred in hospitals. The variables positively associated with deaths at home were: men, age between 70 and 79 years and 80 years or older, mixed-race and Indigenous ethnicity, no formal education and one to three years of formal education, and widowed or other marital status. The Northeast and South regions had the highest rates of home mortality, while the Southeast and South regions led in hospital mortality. There was an increasing trend for both deaths occurring at home and those in hospitals nationwide. In the evaluation of home deaths, an increasing trend was observed in nine states and in the Federal District. Regarding hospital deaths, all Brazilian states showed an increasing trend.

CONCLUSION

The factors that influence the place of death for cancer patients are complex and include support network, access, culture, and the use of healthcare services. Targeted actions for more vulnerable populations and locations are necessary to reverse the growing trend of this condition.

Factors associated with family decision-making self-efficacy among family members of patients with advanced cancer in mainland China

OBJECTIVES

In Chinese culture, family members are the main decision maker on end-of-life (EoL) issues for patients with advanced cancer. Yet little is known about Chinese families' confidence in making EoL decisions and its associated factors. This study aims to investigate the status and associated factors of Chinese family members' confidence in making EoL decisions for patients with advanced cancer.

METHODS

This cross-sectional study used a convenience sample of 147 family members of patients with stage III or stage IV cancer from a tertiary cancer center in Guangzhou, China. The questionnaires included demographic information of patients and their family members, patients' EoL preferences, and the Chinese version of the Family Decision-Making Self-Efficacy (FDMSE) Scale.

RESULTS

A total of145 family members (98.64%) completed the questionnaires. The average score of FDMSE was 3.92 ± 0.53. A multiple regression analysis showed that the factors associated with FDMSE included patients' duration of disease, health insurance, participation in EoL decision-making, the expression of unfilled wishes, and family members' employment status.

SIGNIFICANCE OF RESULTS

Chinese family members were not confident enough in making EoL decisions for patients with advanced cancer. It is recommended to develop cultural-tailored advanced care planning models to clarify patient preferences and to enhance the family members' self-efficacy in making EoL decisions with or for patients with advanced cancer.

Journey to inpatient hospice care: A qualitative study on the decision-making process of Chinese family caregivers of persons with terminal cancer

OBJECTIVE

To understand family caregivers' decision-making process to place their family members with terminal cancer in inpatient hospice care, especially in the social-cultural contexts whereby the caregivers have a dominant say about the care of their seriously ill family members.

METHODS

A qualitative study with a phenomenological approach was undertaken to understand the lived experience of caregivers of persons with terminal cancer in the decision-making process. Semi-structured qualitative interviews were conducted with a purposive sample of 17 caregivers in Shanghai, China. Thematic analysis was used to analyze the data.

RESULTS

The caregivers underwent a winding and socioculturally mediated four-stage process. The stages are (i) trigger for alternatives: lost hope for a cure, (ii) meandering the see-saw process, (iii) the last straws: physical limitations and witnessing unbearable suffering, and (iv) the aftermath: acceptance versus lingering hope. Caregivers' attitudes towards death and their family members with advanced cancer expressed care wishes influence the state of the aftermath.

CONCLUSIONS

Chinese sociocultural values and beliefs about caregiving and death provide insightful explanations for the observed process.

PRACTICAL IMPLICATIONS

Training healthcare professionals in cultural competence, developing an effective hospice referral system, and delivering socioculturally acceptable death education are critical interventions to facilitate better decision-making experiences.

Cost-effectiveness analysis of continuing bevacizumab plus chemotherapy versus chemotherapy alone after first progression of metastatic colorectal cancer

BACKGROUND

Continuation of bevacizumab plus second-line chemotherapy has significantly improved overall and progression-free survival in patients with metastatic colorectal cancer (mCRC). However, the cost-effectiveness of such high cost therapy is still uncertain in China; so this analysis was performed to evaluate the cost-effectiveness of these treatment options from the Chinese health care system perspective.

METHODS

A cost-effectiveness analysis was conducted using data from the ML18147 trial (ClinicalTrials.gov identifier NCT00700102) by modeling a partitioned survival model. Main evaluation indicators were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) with a willingness to pay (WTP) threshold of $38,201 per QALY. One-way and probabilistic sensitivity analyses were conducted to assess the robustness and stability of the model. Subgroup and scenario analyses were also performed to make our study more relevant.

RESULTS

Bevacizumab plus chemotherapy increased 0.12 QALYs and an incremental cost of $22,761.62 compared with chemotherapy, resulting in an ICER of $188,904.09 per QALY. The model was most sensitive to the utility of progression-free survival and the cost of bevacizumab. Compared with chemotherapy, bevacizumab plus chemotherapy had a 0% cost-effectiveness probability, and no cost-effectiveness in subgroups at the WTP threshold of $38,201 per QALY. The scenario analysis found that bevacizumab biosimilar gained an ICER of $126,397.38 per QALY when assuming the cost of drugs was calculated at the most affordable price.

CONCLUSIONS

At the WTP threshold of $38,201 per QALY, continuation of bevacizumab plus chemotherapy is unlikely considered cost-effective for patients after first progression of mCRC.