Palliative Medicine Reports (May 2024)

Survival Time Disparities after Palliative Care Use Among Low-Income Patients on Social Welfare Programs: A Retrospective Cohort Study

  • Daisuke Nishioka,
  • Iku Kanzaki,
  • Ayumi Kihara

DOI
https://doi.org/10.1089/PMR.2023.0077
Journal volume & issue
Vol. 5, no. 1
pp. 187 – 193

Abstract

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Background: Relieving the total pain of patients with cancer and supporting their well-being throughout their lives are important roles of palliative and supportive care. Poverty may inhibit patients from receiving dignified end-of-life care; however, using social welfare services may reduce its impact on patients? end-of-life experiences. Nevertheless, no study has investigated which social welfare service could lead to favorable end-of-life experiences for patients living in poverty. Objective: This study aimed to describe the characteristics of users of palliative care among low-income patients and examine the difference in survival time among patients with cancer on social welfare services in a single center in Kyoto, Japan. Design: We conducted a retrospective cohort study. Setting/Subjects: We included 220 patients using Public Assistance (PA: aid minimum income and medical/long-term care), Free/Low-Cost Medical Care (FLCMC: aid only medical care), and nonwelfare-users who newly received palliative care in 2021. Measurements: We calculated patients? survival time from the initiation of palliative care to death. In addition, we identified patients who experienced home death. Results: Compared with nonusers, FLCMC beneficiaries had shorter survival times (adjusted hazard ratio [aHR] 2.05, 95% confidence interval [CI] 0.80?5.22). No difference was observed among PA beneficiaries (aHR 1.19, 95% CI 0.49?2.87). No home death was observed among welfare service recipients. Conclusions: Social welfare benefits only for medical expenses may not sufficiently support dignified end-of-life care for low-income patients. Further studies are required to examine the robustness of this study considering various bio-psycho-social factors that can influence these findings, to support low-income patients with cancer on social welfare services.

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