Association of Early Palliative Care with End-of-Life Care Quality and Nonbeneficial Treatments in Taiwan: A Nationwide Population-Based Study

Background: Early palliative care has been associated with reduced aggressive care near the end of life (EOL), particularly among patients with cancer. However, evidence regarding the association between early palliative care and potentially nonbeneficial treatments near the EOL remains limited, particularly among patients with noncancer terminal illnesses and in real-world clinical practice. Objectives: To examine the association between early palliative care, EOL care quality indicators, and nonbeneficial treatments among terminally ill cancer and noncancer patients under a universal health insurance system. Methods: This retrospective population-based study used Taiwan’s National Health Insurance Research Database to identify adults who received palliative care within one year before death in 2019. Early palliative care was defined as initiation of any palliative care service more than 90 days before death. Outcomes included indicators of EOL care quality and nonbeneficial treatments within the last 30 days of life. Multivariable logistic and linear regression models were used to adjust for demographic characteristics, comorbidities, and terminal diagnoses. Results: Among 46,343 decedents, 17.2% received early palliative care. Early palliative care was associated with lower odds of aggressive EOL care, including more than one emergency department visit, more than one hospitalization, a hospital stay exceeding 14 days, intensive care unit admission, in-hospital death, use of an endotracheal tube, ventilator support, and cardiopulmonary resuscitation. Early palliative care was also associated with reduced use of nonbeneficial treatments, including blood transfusion and tube feeding or intravenous nutrition. Conclusion: In a nationwide cohort, early palliative care was associated with improved EOL care quality and reduced use of nonbeneficial treatments among terminally ill patients. These findings underscore the clinical importance of earlier palliative care involvement in supporting patient-centered decision making near the EOL and reducing potentially nonbeneficial interventions.