Hospice preference among families with cancer patients in China: An exploratory study

Abstract Background: The reasons for hospice underuse in China needs exploration from the perspective of patients with cancer and their families. Furthermore, existing literature about hospice decision-making among Chinese families with cancer patients is limited. This study aimed to investigate the awareness of hospice care among families with cancer patients, their preference of healthcare at the end-of-life stage of care, and the predictors of hospice preference.Methods: This was an exploratory study conducted between July 2021 and January 2022. Overall, 300 decision-makers of cancer patients were recruited from the oncology ward of seven hospitals in Shanghai, China. Of these, 285 valid responses were included in the data analysis. A self-developed questionnaire about their preference of healthcare when the patient was at the end-of-life stage was completed. Descriptive analysis, t-test, chi-square test, and logistic regression were conducted to analyze the data.Results: Only 29.7% of the participants had heard of hospice care. Most participants (78.2%) reported no introduction of hospice care from their doctors. More than half of the participants (58.2%) did not have a preference of healthcare at the end-of-life stage. Seventy-eight (65.5%) of the 119 participants who had a preference chose hospice care, and the other 41 participants (34.5%) refused hospice care. Having heard of hospice care had a significant impact on having a preference for healthcare at the end-of-life stage (OR=14.346, 95%CI 7.219-28.509, p<0.001). Not being sure whether the doctor introduced hospice care before had a significant impact on having no preference for healthcare at the end-of-life stage (OR=0.180, 95%CI 0.052-0.617, p=0.006). Another family member being cared for at home had a significant impact on the participants’ hospice preference (OR=2.739, 95%CI 1.159-6.470, p=0.022).Conclusion: The end-of-life communication between healthcare providers and the families of cancer patients is insufficient. More efforts should be made in increasing the awareness of hospice care among patients with cancer and their families. Further study is needed to explore the reasons for a lack of discussion on hospice options between healthcare providers and the families. Additionally, the impact of at-home care burden on the hospice choice of families with cancer patients requires further study.