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Cumulative multidisciplinary team messages and home death after palliative care unit discharge in advanced cancer: a
Shinya Kajiura1, Nozomu Murakami2,3, Shinji Fujioka3
1Department of Medical Oncology and Palliative Medicine, Toyama University Hospital, 2630 Sugitani, Toyama, Toyama Prefecture, 930-0194, Japan. shin-ya@nsknet.or.jp.
Background:
Advanced cancer patients leaving a palliative care unit (PCU) require coordinated hospital-community transition support, yet outcome-linked evidence from real-world post-PCU regional coordination infrastructure remains limited.
Methods:
This prospective cohort study included consecutive advanced cancer patients registered on an ICT-supported communication platform in anticipation of PCU discharge in a Japanese regional care model between June 2018 and August 2022 (n = 169). The exposure was cumulative post-discharge multidisciplinary team messages, modeled as log2(1 + messages). The outcome was home death. Multivariable logistic regression adjusted for age, sex, major cancer category, and baseline palliative prognostic index.
Results:
Among 169 patients, 98 (58.0%) died at home. Median cumulative team messages were 19 (IQR, 9-31). Higher cumulative message volume was associated with home death (adjusted odds ratio, 1.48; 95% confidence interval, 1.13-1.93; p = 0.004). Sensitivity analyses were directionally consistent, although the estimate attenuated after excluding patients with 0 days of observed post-discharge home follow-up.
Conclusions:
Within this regional post-PCU transition model, cumulative multidisciplinary team message volume was associated with home death. Message volume should be interpreted as an implementation-level marker of ICT-mediated communication-system use, infrastructure use, and communication opportunity, not as a causal intervention dose, a direct measure of coordination quality, or evidence that ICT itself improved outcomes. These findings may inform palliative oncology discharge planning and regional care-system design.
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