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Background <p>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.</p> Methods <p>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 (<i>n</i> = 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.</p> Results <p>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; <i>p</i> = 0.004). Sensitivity analyses were directionally consistent, although the estimate attenuated after excluding patients with 0 days of observed post-discharge home follow-up.</p> Conclusions <p>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.</p>

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Cumulative multidisciplinary team messages and home death after palliative care unit discharge in advanced cancer: a prospective regional implementation cohort study

  • 期刊论文

  • 发表日期：

    2026年7月4日

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  • Shinya Kajiura,
  • Nozomu Murakami,
  • Shinji Fujioka,
  • Kenichirou Tsukada,
  • Yoshio Minabe,
  • Ryuji Hayashi

摘要

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.