Factors Affecting the Use of Hospice Care and Timing of Its Initiation: Comparing Single and Combined Hospice Users Among Korean Adult Cancer Decedents.

Purpose: This study aimed to identify the factors affecting the use of single and combined hospice care and timing of hospice initiation, thereby providing a basis for improving the continuity and quality of hospice care. Methods: Statistics on cancer-related deaths in 2019 from Statistics Korea and administrative data from the National Health Insurance Service were obtained. Multiple logistic regression and multiple linear regression analyses were performed to identify factors associated with combined (versus single) hospice use and the timing of hospice initiation before death, based on Andersen's model, among 19,334 patients who used hospice care. Results: Among the participants, 18.7% used combined hospice care. Factors associated with the utilization of combined hospice care were gender, income, residential area, location of the primary medical institution, type of the primary medical institution, whether the primary medical institution and residential area were in the same location, Charlson Comorbidity Index (CCI), and primary cancer type. Combined hospice users initiated hospice care 25.7 days earlier than single hospice users. Patients who initiated hospice care early were in their 60s, resided in a capital city, used medical institutions located in urban areas and designated as hospice-specialized institutions, had CCI ≥2, and were diagnosed with prostate cancer. Conclusion: To improve accessibility to combined hospice care for patients with terminal cancer in Korea, care should be provided equitably based on patients' disease status and region of residence.