Longitudinal patterns and predictors of healthcare utilization among cancer patients on home-based palliative care in Singapore: a group-based multi-trajectory analysis

Zhuang, Qingyuan; Chong, Poh-Heng; Ong, Whee Sze; Yeo, Zhi Zheng; Foo, Cherylyn Qun Zhen; Yap, Su Yan; Lee, Guozhang; Yang, Grace Meijuan; Yoon, Sungwon

doi:10.1186/s12916-022-02513-y

Table 1 Baseline characteristics separated by trajectory groups^a

From: Longitudinal patterns and predictors of healthcare utilization among cancer patients on home-based palliative care in Singapore: a group-based multi-trajectory analysis

Variable	Group 1		Group 2		Group 3		Total
Variable	No.	%	No.	%	No.	%	No.	%
Overall	551	100.0	664	100.0	357	100.0	1572	100.0
Age, years^b	74 (65–83)		70 (63–79)		66 (58–75)		71 (62–80)
Gender
Male	267	48.5	340	51.2	162	45.4	769	48.9
Female	284	51.5	324	48.8	195	54.6	803	51.1
Ethnicity
Chinese	444	80.6	525	79.1	282	79.0	1251	79.6
Malay	59	10.7	71	10.7	38	10.6	168	10.7
Indian	27	4.9	40	6.0	20	5.6	87	5.5
Others	21	3.8	28	4.2	17	4.8	66	4.2
Religion
Christianity (all denominations)	107	19.4	126	19.0	76	21.3	309	19.7
Buddhism	247	44.8	305	45.9	154	43.1	706	44.9
Taoism	50	9.1	50	7.5	35	9.8	135	8.6
Islam	87	15.8	103	15.5	51	14.3	241	15.3
Hinduism	15	2.7	25	3.8	13	3.6	53	3.4
Others	11	2.0	16	2.4	8	2.2	35	2.2
No religion	31	5.6	37	5.6	19	5.3	87	5.5
Missing	3	0.5	2	0.3	1	0.3	6	0.4
Marital status
Single	27	4.9	51	7.7	25	7.0	103	6.6
Married	345	62.6	455	68.5	258	72.3	1058	67.3
Separated/divorced	23	4.2	30	4.5	24	6.7	77	4.9
Widowed	156	28.3	128	19.3	50	14.0	334	21.2
Residential status
Singapore citizen	530	96.2	637	95.9	340	95.2	1507	95.9
Permanent resident	21	3.8	27	4.1	17	4.8	65	4.1
At least one ACP component completed^d
No	207	37.6	341	51.4	181	50.7	729	46.4
Yes	344	62.4	323	48.6	176	49.3	843	53.6
Preferred place of care
Hospital	30	5.4	60	9.0	35	9.8	125	8.0
Home	276	50.1	217	32.7	114	31.9	607	38.6
Others	24	4.4	22	3.3	9	2.5	55	3.5
No preference	9	1.6	17	2.6	7	2.0	33	2.1
Missing	5	0.9	7	1.1	11	3.1	23	1.5
ACP not done	207	37.6	341	51.4	181	50.7	729	46.4
Preferred place of death
Home	270	49.0	194	29.2	108	30.3	572	36.4
Hospice	21	3.8	32	4.8	17	4.8	70	4.5
Others	11	2.0	11	1.7	10	2.8	32	2.0
No preference	37	6.7	69	10.4	33	9.2	139	8.8
Missing	5	0.9	17	2.6	8	2.2	30	1.9
ACP not done	207	37.6	341	51.4	181	50.7	729	46.4
Preferred plan of care
Full active	1	0.2	8	1.2	5	1.4	14	0.9
Limited intervention	93	16.9	120	18.1	60	16.8	273	17.4
Comfort only	229	41.6	163	24.5	84	23.5	476	30.3
Missing	21	3.8	32	4.8	27	7.6	80	5.1
ACP not done	207	37.6	341	51.4	181	50.7	729	46.4
Patient awareness of diagnosis
No	226	41.0	227	34.2	89	24.9	542	34.5
Yes	325	59.0	436	65.7	268	75.1	1029	65.5
Missing	0	0.0	1	0.2	0	0.0	1	0.1
Patient awareness of prognosis
No	304	55.2	319	48.0	149	41.7	772	49.1
Yes	247	44.8	344	51.8	208	58.3	799	50.8
Missing	0	0.0	1	0.2	0	0.0	1	0.1
Family awareness of diagnosis
No	13	2.4	38	5.7	23	6.4	74	4.7
Yes	538	97.6	625	94.1	334	93.6	1497	95.2
Missing	0	0.0	1	0.2	0	0.0	1	0.1
Family awareness of prognosis
No	52	9.4	78	11.7	53	14.8	183	11.6
Yes	499	90.6	585	88.1	304	85.2	1388	88.3
Missing	0	0.0	1	0.2	0	0.0	1	0.1
Housing value index^c
High	127	23.0	130	19.6	75	21.0	332	21.1
Medium	373	67.7	479	72.1	256	71.7	1108	70.5
Low^c	51	9.3	55	8.3	26	7.3	132	8.4
Medical subsidy means testing
0%	110	20.0	153	23.0	96	26.9	359	22.8
1–25%	4	0.7	4	0.6	4	1.1	12	0.8
26–50%	98	17.8	102	15.4	66	18.5	266	16.9
51–80%	320	58.1	386	58.1	182	51.0	888	56.5
Not done	19	3.4	19	2.9	9	2.5	47	3.0
Main caregiver
Self	4	0.7	7	1.1	12	3.4	23	1.5
Spouse	102	18.5	142	21.4	104	29.1	348	22.1
Relatives (children included in category)	435	78.9	498	75.0	236	66.1	1169	74.4
Others	6	1.1	14	2.1	3	0.8	23	1.5
Missing	4	0.7	3	0.5	2	0.6	9	0.6
Primary decision maker
Self	4	0.7	7	1.1	12	3.4	23	1.5
Spouse	102	18.5	142	21.4	104	29.1	348	22.1
Children	394	71.5	433	65.2	208	58.3	1035	65.8
Other relative	41	7.4	68	10.2	30	8.4	139	8.8
Others	4	0.7	11	1.7	2	0.6	17	1.1
Missing	6	1.1	3	0.5	1	0.3	10	0.6
Living arrangement
Alone	17	3.1	26	3.9	19	5.3	62	3.9
With spouse only	56	10.2	89	13.4	46	12.9	191	12.2
With children only	153	27.8	140	21.1	64	17.9	357	22.7
With spouse and children	125	22.7	186	28.0	115	32.2	426	27.1
With relatives	22	4.0	37	5.6	15	4.2	74	4.7
Others	174	31.6	179	27.0	96	26.9	449	28.6
Missing	4	0.7	7	1.1	2	0.6	13	0.8
Primary cancer diagnosis
Lip, oral cavity, and pharynx	22	4.0	18	2.7	14	3.9	54	3.4
Digestive organs	230	41.7	322	48.5	108	30.3	660	42.0
Respiratory and intrathoracic organs	107	19.4	129	19.4	70	19.6	306	19.5
Breast	36	6.5	40	6.0	39	10.9	115	7.3
Female genital organs	48	8.7	63	9.5	44	12.3	155	9.9
Male genital organs	20	3.6	24	3.6	15	4.2	59	3.8
Urinary tract	25	4.5	18	2.7	18	5.0	61	3.9
Lymphoid, haematopoietic, and related tissue	17	3.1	11	1.7	22	6.2	50	3.2
Others	46	8.3	39	5.9	27	7.6	112	7.1
Charlson Comorbidity Index^b	8 (7–9)		8 (8–10)		8 (8–9)		8 (8–9)
ECOG performance status
0–2	174	31.6	257	38.7	186	52.1	617	39.2
3–4	327	59.3	320	48.2	121	33.9	768	48.9
Not assessed	50	9.1	87	13.1	50	14.0	187	11.9
Survival post enrolment in home hospice care, weeks	10.1 (4.5–21.7)		6.7 (3.8–11.6)		17.5 (8.8–32.6)		9.4 (4.7–19.3)

Abbreviation: ACP advanced care planning, ECOG Eastern Cooperative Oncology Group
^aGroup 1 = persistently low emergency visits, outpatient visits and hospitalizations, group 2 = persistently high emergency visits and hospitalizations with moderately high outpatient visits, group 3 = high outpatient visits and moderately high emergency visits and hospitalizations which all dip before rising over time
^bData presented is median (interquartile range)
^cHousing value index low corresponds to high housing subsidy (public HDB 1–2 rooms flat), medium to moderate housing subsidy (public HDB 3–4 rooms flat), and high to minimal or no housing subsidy (public HDB 5-room or larger flats and private housing)
^dACP components are (1) preferred place of care, (2) preferred place of death, and (3) preferred plan of care

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