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Ahn E, Song IG, Choi JY, Jho HJ, Park I, Sung S, Shin S, Park SJ, Nam EJ, Jeong SH, Chang YJ. Effectiveness of home hospice care: a nationwide prospective observational study. Support Care Cancer 2019; 28:2713-2719. [PMID: 31691034 DOI: 10.1007/s00520-019-05091-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Many assert the need for home hospice care. However, limited research has shown its effectiveness. The authors of this study thus evaluated the effectiveness of a home hospice care pilot project regarding (1) early enrollment in hospice care, (2) efficient use of inpatient hospice resources, and (3) enabling terminally ill patients to stay at their preferred place of care. METHODS The authors conducted a nationwide prospective observational study. Patients were divided into home hospice care users (ever-users, n = 902) and inpatient-only hospice care users (never-users, n = 8210). Information about hospice service utilization was collected from a web-based registry system. Patients were registered if they started to receive the hospice service after providing written informed consent during the pilot project from March 2016-July 2017. RESULTS Most ever-users preferred to stay at home (84.0%), while never-users preferred hospital admission (66.9%). Most ever-users were enrolled in hospice by home care (78.9%) and used both home and inpatient care (72.4%). The overall duration of hospice care was significantly longer among ever-users than never-users (median 39 vs. 15 days, respectively; mean ± SD 59.6 ± 62.8 vs. 24.8 ± 32.1, respectively; p < .001). Participation in the pilot program improved bed utilization (p = .025) and turnover rate (p < .001) of inpatient hospice service. CONCLUSIONS Home hospice care enabled early enrollment in hospice services and provided a valid option to patients who wished to stay at home. Policy efforts to facilitate home hospice care are needed.
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Affiliation(s)
- Eunmi Ahn
- Division of Health Services Development for Persons with Disabilities, Ministry of Health and Welfare National Rehabilitation Center, 58 Samgaksan-ro, GangBuk-gu, Seoul, 01022, South Korea
| | - In Gyu Song
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Young Choi
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Hyun Jung Jho
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Ilyeon Park
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Suah Sung
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Seohyun Shin
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - So Jung Park
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Eun Jung Nam
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Sung Hoon Jeong
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Yoon Jung Chang
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea.
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Park CH, Shin DW, Choi JY, Kang J, Mo HN, Baik YJ, Kim YH, Kang MJ, Gwak JI, Lee JJ. Determinants of Family Satisfaction with Inpatient Palliative Care in Korea. J Palliat Care 2018. [DOI: 10.1177/082585971302900205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We aimed to identify which structures and processes of care are key determinants of overall satisfaction with palliative care. Methods: A nationwide, multicentre, cross-sectional questionnaire survey was conducted with 501 bereaved family members of terminal cancer patients (effective response rate: 20.9 percent). Structures and processes were evaluated using the Care Evaluation Scale (CES). Results: In univariate analyses, all domains of the CES were significantly associated with overall satisfaction with care. In multivariate analyses, the domains of physical care by physician, physical care by nurse, environment, and coordination positively influenced overall satisfaction. After case-mix adjustment, physical care by nurse, age of patient, and lower education level of bereaved family member remained as significant determinants. Conclusion: Our finding that nursing is the most critical determinant of overall satisfaction within many structure and process domains has an important implication for clinical quality improvement and resource allocation.
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Affiliation(s)
- Chang-Hae Park
- DW Shin (corresponding author) Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Dong-Wook Shin
- DW Shin (corresponding author) Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Jin Young Choi
- Department of Family Medicine, Eulji University Hospital, Daejeon, Korea, and Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jina Kang
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Ha Na Mo
- Daegu Medical Center, Daegu, Republic of Korea
| | - Young Ji Baik
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Yeo Hwan Kim
- okpo Jung Ang Hospital, Mokpo, Republic of Korea
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Park SJ, Nam EJ, Chang YJ, Lee YJ, Jho HJ. Factors Related with Utilizing Hospice Palliative Care Unit among Terminal Cancer Patients in Korea between 2010 and 2014: a Single Institution Study. J Korean Med Sci 2018; 33:e263. [PMID: 30288159 PMCID: PMC6170669 DOI: 10.3346/jkms.2018.33.e263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 07/13/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Establishing and designating specialized hospice palliative care units (HPCUs) has been an important part of national policy to promote hospice palliative care in Korea in the recent decade. However, few studies have sought to identify patterns and barriers for utilizing HPCU over the period of national policy implementation. We aimed to investigate factors related with utilizing HPCU for terminal cancer patients after consultation with a palliative care team (PCT). METHODS We reviewed medical records for 1,028 terminal cancer patients who were referred to the PCT of the National Cancer Center in 2010 and 2014. We compared the characteristics of the patients who decided to utilize HPCU and those who did not. We also analyzed factors influencing choices for a medical institution and reasons for not selecting an HPCU. RESULTS The patients' mean age was 61.0 ± 12.2, with lung cancer patients (24.3%) comprising the largest percentage of these patients. The percentage of referred patients who utilized an HPCU was 53.9% in 2014, increasing from 44.6% in 2010. Older age and awareness of terminal illness were found to be positively associated with utilization of an HPCU. The most common reason for not selecting an HPCU was "refusing hospice facility" (34.9%), followed by "near death," "poor accessibility to an HPCU," and "caregiving problems." CONCLUSION Compared to 2010, HPCU utilization by terminal cancer patients increased in 2014. Improving awareness of terminal condition among patients and family members and earlier discussion of end-of-life care would be important to promote utilization of HPCU.
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Affiliation(s)
- So-Jung Park
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Jeong Nam
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yoon Jung Chang
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yong-Jae Lee
- Department of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Hyun Jung Jho
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
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Shin DW, Lee JE, Cho B, Yoo SH, Kim S, Yoo JH. End-of-life communication in Korean older adults: With focus on advance care planning and advance directives. Geriatr Gerontol Int 2015; 16:407-15. [DOI: 10.1111/ggi.12603] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine; Seoul National University College of Medicine & Seoul National University Hospital; Seoul Korea
- Center for Health Promotion and Optimal Aging; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior; Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
- JW Lee Center for Global Medicine; College of Medicine; Seoul National University; Seoul Korea
| | - Ji Eun Lee
- Department of Family Medicine; Seoul National University College of Medicine & Seoul National University Hospital; Seoul Korea
- Center for Health Promotion and Optimal Aging; Seoul National University Hospital; Seoul Korea
| | - BeLong Cho
- Department of Family Medicine; Seoul National University College of Medicine & Seoul National University Hospital; Seoul Korea
- Center for Health Promotion and Optimal Aging; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior; Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
- Institute on Aging; Seoul National University College of Medicine; Seoul Korea
- Advanced Institutes of Convergence Technology; Seoul National University; Gyeonggi-do Korea
| | - Sang Ho Yoo
- Department of Medical Education; College of Medicine; Hanyang University; Seoul Korea
| | - SangYun Kim
- Department of Neurology; Seoul National University College of Medicine & Seoul National University Bundang Hospital; Seoul Korea
| | - Jun-Hyun Yoo
- Department of Family Medicine; Sungkyunkwan University College of Medicine & Samsung Medical Center; Seoul Korea
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Rhee YJ. Hospice and Palliative Care Services in South Korea Supported by the National Health Insurance (NHI) Program. Health (London) 2015. [DOI: 10.4236/health.2015.76082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Association between the duration of palliative care service and survival in terminal cancer patients. Support Care Cancer 2014; 23:1057-62. [PMID: 25281228 DOI: 10.1007/s00520-014-2444-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/14/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE Preliminary studies of early palliative care showed improved quality of life, less medical cost, and better survival time. But, most terminal cancer patients tend to be referred to palliative care late. For the proper care of terminal cancer patients, it is necessary to refer to hospice and palliative care timely. The aim of this study is to analyze the effect of the duration of palliative care services on the survival in terminal cancer patients. METHODS We reviewed 609 patients who had died from terminal cancer between January 2010 and December 2012. We analyzed correlations of age, first Palliative Performance Scale (PPS) level, duration of palliative care service, and survival time. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. RESULTS Duration of palliative care services was significantly correlated with survival time. In univariate Cox regression analysis, age, and each group of duration of palliative care service showed significant associations with survival. Final multivariate Cox regression model retained four parameters as independent prognostic factors for survival (age HR = 0.99 (p = 0.002), 1∼10 days HR = 2.64 (p < 0.001), 11∼30 days HR = 2.43 (p < 0.001), 31∼90 days HR = 1.87 (p < 0.001)). CONCLUSIONS Shorter duration of palliative care services showed poor prognostic factor. Timely referral system from the end of chemotherapy is warranted.
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Morishima T, Lee J, Otsubo T, Ikai H, Imanaka Y. Impact of hospital case volume on quality of end-of-life care in terminal cancer patients. J Palliat Med 2012; 16:173-8. [PMID: 23140184 DOI: 10.1089/jpm.2012.0361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Quality of end-of-life (EOL) care is gaining increasing attention. However, the relationship between hospital case volume and performance of benchmark quality indicators is not well characterized. The aim of this study was to determine whether hospital case volume affects EOL care for terminal cancer patients. METHODS We conducted a retrospective cross-sectional study using claims data of patients who died of cancer at acute-care hospitals in Kyoto prefecture, Japan, between March 2009 and May 2010. Hospitals were grouped into tertiles based on the number of terminal cancer cases. We used multilevel logistic regression models to examine the association of the following quality indicators with the tertiles: opioid use during the last 2 months of life (indicating good quality of care), provision of intensive care unit (ICU) service or life-sustaining treatments during the last month of life (poor quality), and chemotherapy during the last month of life (poor quality). RESULTS The final sample for analysis consisted of 3294 decedents from 88 hospitals. Significant associations between hospital case volume and quality of EOL care were identified after adjusting for patient and hospital characteristics. Small- and medium-volume hospitals were found to be less likely to administer opioids, and medium-volume hospitals were more likely to provide ICU service or life-sustaining treatments when compared with large-volume hospitals. No significant association between chemotherapy use and case volume was observed. CONCLUSIONS The results showed that the case volume of terminally ill cancer patients was associated with several aspects of quality of EOL care.
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Affiliation(s)
- Toshitaka Morishima
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
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Shin DW, Choi JE, Miyashita M, Choi JY, Kang J, Baik YJ, Mo HN, Kim YS, Heo DS, Shin HJ. Measuring the structure and process of end-of-life care in Korea: validation of the Korean version of the Care Evaluation Scale (CES). J Pain Symptom Manage 2012; 44:615-625.e2. [PMID: 22732418 DOI: 10.1016/j.jpainsymman.2011.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 05/31/2011] [Accepted: 10/10/2011] [Indexed: 11/17/2022]
Abstract
CONTEXT A reliable and valid measure of structure and process of end-of-life care is important for improving the outcomes of care. OBJECTIVES This study examined the validity and reliability of the Korean version of Care Evaluation Scale (CES), which was developed in Japan to evaluate structure and process of palliative care from the perspective of bereaved family members. METHODS Standard forward-backward translation and a pilot test were conducted. A multicenter cross-sectional survey was conducted with bereaved family members (n=501) of patients who had died from cancer two to six months before the study. Descriptive analyses were performed. The reliability of the CES was tested by Cronbach's alpha. The dimensional structure was assessed using confirmatory factor analyses. Concurrent and discriminant validity were tested by correlation with the overall satisfaction with care, patient's overall quality of life (QoL), and family member's own QoL as measured by the EQ-5D. RESULTS Participants could complete the CES readily, with low missing response rates. Cronbach's alpha for internal consistency was 0.93 overall, and ranged from 0.88 to 0.94 for subdomains. The hypothesized 10 subscale model of the CES appeared to fit the data (goodness-of-fit index=0.854). The overall score of the CES moderately correlated with overall satisfaction with care (r=0.54, P<0.001), more weakly correlated with the patient's QoL (r=0.32, P<0.001), but did not correlate with the family member's QoL (r=0.03, P=0.548). CONCLUSION The CES was found to be a reliable and a valid measure of the necessity for improvement in the structure and process of end-of-life care from bereaved family members' perspectives.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Kang J, Shin DW, Choi JE, Sanjo M, Yoon SJ, Kim HK, Oh MS, Kwen HS, Choi HY, Yoon WH. Factors associated with positive consequences of serving as a family caregiver for a terminal cancer patient. Psychooncology 2012; 22:564-71. [DOI: 10.1002/pon.3033] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Jina Kang
- National Cancer Control Institute; National Cancer Center; Goyang Korea
| | - Dong Wook Shin
- Department of Family Medicine; Seoul National University Hospital; Seoul Korea
| | - Ji Eun Choi
- National Evidence-based Collaborating Agency; Seoul Korea
| | - Makiko Sanjo
- Department of Adult Nursing/Palliative Care Nursing; The University of Tokyo; Tokyo Japan
| | - Soo Jin Yoon
- College of Nursing; The Catholic University of Korea; Seoul Korea
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