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

Abstract

Provision of quality care may diminish expression of wish to die (WTD), but this relationship has not been empirically assessed. To assess the association between institutional quality of care and expression of WTD among patients with advanced cancer. 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. 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. 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.