Background The reasons for hospice underuse in China need 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 for 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 for healthcare when the patient was at the end-of-life stage was completed. Descriptive analysis, t-test, chi-square test, and multivariable logistic regression were conducted to analyze the data. Results Only 46.0% of the participants have heard of hospice care. Most participants (78.2%) reported no introduction to hospice care from their doctors. More than half of the participants (58.2%) did not have a preference for 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 preferring healthcare at the end-of-life stage (adjusted 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 (adjusted 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 (adjusted 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 patients’ families. Additionally, the impact of the at-home care burden on the hospice choice of families with cancer patients requires further study.

BACKGROUND Cancer is a major public health problem and poses a health threat to the population, and Peripherally Inserted Central Catheters-Unplanned Extubation (PICC-UE) is considered the most adverse event for patient safety. Identifying independent risk factors for PICC-UE, applying high-quality assessment tool early in high-risk population, and adopting precise prevention and treatment can effectively reduce the occurrence of PICC-UE. OBJECTIVE The objective is to identify the independent risk factors for PICC-UE in cancer patients, and to develop a predictive model for PICC-UE for cancer patients, providing a theoretical basis for the prevention and prediction of PICC-UE in cancer patients. METHODS Prospective data were collected from January to December 2022 from cancer patients with PICC at Xiangya Hospital, Central South University, and each patient was followed up until the catheter removal. The patients were divided into UE group (n=3107) and non-UE group (n=284), and independent risk factors were determined by univariate, LASSO algorithm and multivariate analysis. The 3391 patients were then divided into a trainset and a testset according to the ratio of 7:3. The screened predictors were used to build three predictive models using Logistic Regression, Support Vector Machine and Random Forest algorithms, and the optimal model was screened by ROC curve and TOPSIS synthesis analysis. We collected prospective data of 600 cancer patients with PICC from June to December 2022 at the Affiliated Hospital of Qinghai University and Hainan Provincial People's Hospital for external validation. The Area Under the Curve (AUC) of the ROC was used to test the differentiation of the model, and the Calibration Curve to assess the calibration capability and Decision Curve Analysis (DCA) to evaluate the clinical applicability of the model. RESULTS Independent risk factors for PICC-UE in cancer patients included impaired physical mobility (OR=2.775), diabetes (OR=1.754), surgical history (OR=1.734), elevated D-dimer concentration (OR=2.376), targeted therapy (OR=1.441), surgical protocol (OR=1.543), and more than one catheter puncture (OR=1.715); protective factors included normal BMI (OR=0.449), polyurethane catheter material (OR=0.305), and valved catheter (OR=0.639). The results of the TOPSIS synthesis analysis: the Ci values were 0.00, 0.82 and 0.85 in the trainset, and the Ci values were 0.00, 1.00 and 0.81 in the testset for the Logistic, Support Vector Machine and Random Forest models, respectively. The optimal model constructed based on Support Vector Machine was obtained and validated externally, the ROC curve, Calibration curve and DCA curve showed that the model had excellent accuracy, stability, generalizability and clinical applicability. CONCLUSIONS Ten independent predictors of PICC-UE in cancer patients were obtained in this study. The predictive model was constructed based on Support Vector Machine, which has clinical application value through external validation, and provides significant support for the early prediction of PICC-UE in cancer patients.

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.