"Wish to Die" Among Patients With Advanced Cancer: Does Institutional Quality of Care Matter?

CONTEXT: Provision of quality care may diminish expression of wish to die (WTD), but this relationship has not been empirically assessed. OBJECTIVES: To assess the association between institutional quality of care and expression of WTD among patients with advanced cancer. METHODS: We surveyed patients with advanced cancer from 9 hospitals in 8 low- and middle- income countries (Bangladesh, China, India, Thailand, the Philippines, Myanmar, Sri Lanka and Vietnam). We estimated mixed-effects logistic regression model to assess the relationship between patient and provider reported quality of care with WTD. RESULTS: 12.4% of patients in our sample (N = 1648) expressed a WTD, with rates varying between 2% and 45% across institutions. Patients who reported better care coordination (OR:0.63, 95% CI: [0.45,0.89] and nursing care (OR: 0.63, 95% CI: [0.45,0.87]) had lower odds, whereas those reporting better physician communication had higher odds of a expressing a WTD (OR: 1.99, 95% CI: [1.40,2.81]). Patients receiving care at institutions permitting longer durations of morphine prescriptions (OR: 0.96, 95% CI: [0.93,0.99]), those at institutions with a higher proportion of specialist palliative care physicians per 1000 advanced cancer patients treated monthly (OR: 0.97, 95% CI: [0.96,0.99]), and those treated at institutions conducting satisfaction surveys (OR: 0.41, 95% CI: [0.25,0.67]), were less likely to express a WTD. CONCLUSION: Findings underscore that institutional quality of care is associated with reduced likelihood of patients expressing a WTD. Thus, enhancing institutional care quality - particularly improving access to palliative care - is critical for bettering the care of terminally ill.

Duke Scholars

Author Semra Ozdemir Population Health Sciences