biostudies-literatureBell SGNCI NIH HHS515-520https://www.ebi.ac.uk/biostudies/studies/S-EPMC11265618biostudies-literatureUnknown27(4)<b><i>Introduction:</i></b> Therapeutic alliance (TA), or the extent to which patients feel a sense of caring and trust with their physician, may have an impact on health care utilization. We sought to determine if TA is associated with: (1) emergency department (ED) visits within 30 days of death and (2) hospice enrollment. <b><i>Methods and Materials:</i></b> This is a secondary analysis of data from a randomized clinical trial. We used restricted cubic splines to assess the relationship between TA scores and health care utilization. <b><i>Results:</i></b> Six hundred seventy-two patients were enrolled in the study, with 331 (49.3%) dying within 12 months. Patients with higher TA were less likely to have an ED visit in the last 30 days of life, but there was no evidence of a relationship between TA and enrollment in hospice. <b><i>Conclusions:</i></b> Higher TA was associated with decreased ED visits within 30 days of death. There was no association between TA and rates of hospice enrollment. Clinical Registration Number: NCT02712229.Journal of palliative medicineAssociations of Health Care Utilization and Therapeutic Alliance in Patients with Advanced Cancer.PMC11265618P30 CA047904R01 CA197103R37 CA262025Smith KJChu EBell SGWhite DBBelin SCAlthouse ADArnold RMSchenker YThomas THfalseAssociations of Health Care Utilization and Therapeutic Alliance in Patients with Advanced Cancer.<b><i>Introduction:</i></b> Therapeutic alliance (TA), or the extent to which patients feel a sense of caring and trust with their physician, may have an impact on health care utilization. We sought to determine if TA is associated with: (1) emergency department (ED) visits within 30 days of death and (2) hospice enrollment. <b><i>Methods and Materials:</i></b> This is a secondary analysis of data from a randomized clinical trial. We used restricted cubic splines to assess the relationship between TA scores and health care utilization. <b><i>Results:</i></b> Six hundred seventy-two patients were enrolled in the study, with 331 (49.3%) dying within 12 months. Patients with higher TA were less likely to have an ED visit in the last 30 days of life, but there was no evidence of a relationship between TA and enrollment in hospice. <b><i>Conclusions:</i></b> Higher TA was associated with decreased ED visits within 30 days of death. There was no association between TA and rates of hospice enrollment. Clinical Registration Number: NCT02712229.2024-01-01T00:00:00Z2024 Apr2026-06-01T19:20:40.328Z2025-06-26T03:06:04.696ZS-EPMC112656183857433010.1089/jpm.2023.0559