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Discharge Against Medical Advice in Cancer Patients: Insights from a Multicenter Study in Germany
Sarah Krieg1, Sven H Loosen2, Christoph Roderburg2
1Department of Inclusive Medicine, University Hospital Ostwestfalen-Lippe, Bielefeld University, 33617 Bielefeld, Germany.
Cancers
|January 11, 2025
Summary
Discharge against medical advice (DAMA) in cancer patients is linked to demographics, not disease severity. Younger and male patients are more likely to leave hospitals prematurely, highlighting the need for targeted support.
Area of Science:
- Oncology
- Healthcare Management
- Patient Outcomes
Background:
- Discharge against medical advice (DAMA) negatively impacts patient care continuity, increasing readmissions and mortality.
- DAMA prevalence and factors in cancer patients, where treatment adherence is crucial, are understudied.
Purpose of the Study:
- To investigate the prevalence and associated factors of DAMA in a large cohort of hospitalized cancer patients.
- To identify patient demographics and clinical characteristics linked to DAMA in oncology settings.
Main Methods:
- Multicenter, cross-sectional analysis of anonymized data from 36 German hospitals (2019-2023).
- Inclusion of 51,505 cancer patients.
- Multivariate logistic regression to assess DAMA associations with age, sex, cancer type, metastases, and comorbidities.
Main Results:
- DAMA occurred in 0.9% of cancer patient hospitalizations.
- Highest DAMA rates observed in cancers of the lip, oral cavity, pharynx (2.1%), larynx (2.0%), and liver (1.8%).
- DAMA was significantly more frequent in younger patients (≤50 years) (OR: 1.73) and males (OR: 1.46); distant metastases showed no significant association (OR: 0.96).
Conclusions:
- DAMA in cancer patients is primarily associated with demographic and social factors, rather than disease severity.
- Findings suggest a need for strategies addressing psychosocial and economic challenges, especially for younger and male cancer patients.
- Further research is warranted to refine understanding and clinical application of these DAMA associations.
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