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Huang LH, Lin LS, Wang CL, Chang YC, Lee LC, Hu CC, Hsu PS, Chu WM. Palliative Care Consultation Services on Terminally Ill Cancer Patients and Non-Cancer Patients: Trend Analysis from a 9-Year-Long Observational Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189882. [PMID: 34574805 PMCID: PMC8466532 DOI: 10.3390/ijerph18189882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023]
Abstract
Early integration of palliative care for terminally ill cancer and non-cancer patients improves quality of life. However, there are sparse data on results of palliative care consultation services (PCCS) between cancer and non-cancer patients. In this 9-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer and non-cancer patients who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in outcomes of PCCS, including duration of PCCS, the awareness of disease of patients and families before and after PCCS, status of PCCS termination, and DNR declaration before and after PCCS among cancer and non-cancer patients throughout study period. In total, 5223 cancer patients and 536 non-cancer patients received PCCS from 2011 to 2019. The number of people who received PCCS increased stably over the decade, both for cancer and non-cancer patients. The average duration of PCCS for cancer and non-cancer patients was 21.4 days and 18.4 days, respectively. Compared with non-cancer patients, cancer patients had longer duration of PCCS, less DNR declaration (82% vs. 98%, respectively), and more transfers to the palliative care unit (17% vs. 11%, respectively), or for palliative home care (12% vs.8%, respectively). Determinants of late referral to PCCS includes age (OR 0.992, 95% CI 0.987–0.996), DNR declaration after PCCS (OR 1.967, 95% CI 1.574–2.458), patients’ awareness after PCCS (OR 0.754, 95% CI 0.635–0.895), and status of PCCS termination. This 9-year observational study showed that the trend of PCCS among cancer and non-cancer patients had changed over the duration of the study, and early integration of PCCS to all patients is essential for both cancer and non-cancer patients.
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Affiliation(s)
- Ling-Hui Huang
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-H.H.); (L.-S.L.)
| | - Lian-Shin Lin
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-H.H.); (L.-S.L.)
| | - Chun-Li Wang
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Chen Chang
- Technology Transfer and Incubation Center, National Health Research Institutes, Miaoli 35053, Taiwan;
| | - Lung-Chun Lee
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 40705, Taiwan
| | - Chung-Chieh Hu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
| | - Pi-Shan Hsu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, Taichung 40220, Taiwan
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Occupational Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Health Policy and Management, National Taiwan University, Taipei 10617, Taiwan
- Correspondence: ; Tel.: +886-4-2359-2525
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Abe A, Kobayashi M, Kohno T, Takeuchi M, Hashiguchi S, Mimura M, Fujisawa D. Patient participation and associated factors in the discussions on do-not-attempt-resuscitation and end-of-life disclosure: a retrospective chart review study. BMC Palliat Care 2021; 20:6. [PMID: 33407388 PMCID: PMC7789264 DOI: 10.1186/s12904-020-00698-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background Patient participation is a key foundation of advance care planning (ACP). However, a patient himself/herself may be left out from sensitive conversations such as end-of-life (EOL) care discussions. The objectives of this study were to investigate patients’ participation rate in the discussion of Cardiopulmonary Resuscitation (CPR) / Do-Not-Attempt-Resuscitation (DNAR) order, and in the discussion that the patient is at his/her EOL stage (EOL disclosure), and to explore their associated factors. Methods This is a retrospective chart review study. The participants were all the patients who were hospitalized and died in a university-affiliated teaching hospital (tertiary medical facility) in central Tokyo, Japan during the period from April 2018 to March 2019. The following patients were excluded: (1) cardiopulmonary arrest on arrival; (2) stillbirth; (3) under 18 years old at the time of death; and (4) refusal by their bereaved family. Presence or absence of CPR/DNAR discussion and EOL disclosure, patients’ involvement in those discussions, and their associated factors were investigated. Results CPR/DNAR discussions were observed in 336 out of the 358 patients (93.9%). However, 224 of these discussions were carried out without a patient (patient participation rate 33.3%). Male gender (odds ratio (OR) = 2.37 [95% confidence interval (CI) 1.32–4.25]), living alone (OR = 2.51 [1.34–4.71]), and 1 year or more from the date of diagnosis (OR = 1.78 [1.03–3.10]) were associated with higher patient’s participation in CPR/DNAR discussions. The EOL disclosure was observed in 341 out of the 358 patients (95.3%). However, 170 of the discussions were carried out without the patient (patient participation rate 50.1%). Patients who died of cancer (OR = 2.41[1.45–4.03]) and patients without mental illness (OR=2.41 [1.11–5.25]) were more likely to participate in EOL disclosure. Conclusions In this clinical sample, only up to half of the patients participated in CPR/DNAR discussions and EOL disclosure. Female, living with family, a shorter period from the diagnosis, non-cancer, and mental illness presence are risk factors for lack of patients’ participation in CPR/DNAR or EOL discussions. Further attempts to facilitate patients’ participation, based on their preference, are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-020-00698-8.
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Affiliation(s)
- Akiko Abe
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,Palliative Care Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
| | - Masato Kobayashi
- Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, Japan
| | - Mari Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Palliative Care Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Saori Hashiguchi
- Palliative Care Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Palliative Care Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Division of Patient Safety, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
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Ko YT, Ko MC, Huang CM, Lien HY, Woung LC, Huang SJ. Trends of Utilization of Palliative Care and Aggressive End-of-Life Care for Patients Who Died of Cancers and Those Who Died of Noncancer Diseases in Hospitals. J Pain Symptom Manage 2020; 60:1136-1143. [PMID: 32619671 DOI: 10.1016/j.jpainsymman.2020.06.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 01/31/2023]
Abstract
CONTEXT Patients who died of cancers and those who died of noncancer diseases may receive different end-of-life care. OBJECTIVES This study aimed to evaluate the trends of utilization of palliative care and aggressive end-of-life care for patients who died of cancers and those who died of noncancer diseases in hospitals. METHODS The medical records of patients who died in a public hospital because of cancer or other diseases were reviewed. The proportion of those who received palliative care, admitted to intensive care unit (ICU) within 30 days of death, died in ICU, and received cardiopulmonary resuscitation (CPR) within three days of death in 2013-2014, 2015-2016, and 2017-2018, respectively, was investigated. Multivariate logistic regression was applied to evaluate the independent effects of various factors on the risk of receiving aggressive end-of-life care. RESULTS Significant trends of increase in receiving palliative care were found. The proportion of patients who died of noncancer diseases and received palliative care was lower than that of those who died of cancers. Palliative care was associated with a reduced risk of ICU admission within 30 days of death (adjusted odds ratio [AOR] 0.361), death in ICU (AOR 0.208), and receiving CPR within three days of death (AOR 0.057). Patients who died of noncancer diseases had a higher risk of ICU admission within 30 days of death (AOR 5.016), death in ICU (AOR 5.086), and receiving CPR within three days of death (AOR 3.274). CONCLUSION Utilization of palliative care is increasing. Patients who died of noncancer diseases received less palliative care but more aggressive end-of-life care than those who died of cancers.
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Affiliation(s)
- Yen-Ting Ko
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Medical Education, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Ming-Chung Ko
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan; Taipei City Hospital, Taipei City, Taiwan
| | | | - Hsin-Yi Lien
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan; Taipei City Hospital, Taipei City, Taiwan
| | - Lin-Chung Woung
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan; Taipei City Hospital, Taipei City, Taiwan; School of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Sheng-Jean Huang
- Taipei City Hospital, Taipei City, Taiwan; School of Medicine, National Taiwan University, Taipei City, Taiwan.
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Kim JW, Choi JY, Jang WJ, Choi YJ, Choi YS, Shin SW, Kim YH, Park KH. Completion rate of physician orders for life-sustaining treatment for patients with metastatic or recurrent cancer: a preliminary, cross-sectional study. BMC Palliat Care 2019; 18:84. [PMID: 31640677 PMCID: PMC6806497 DOI: 10.1186/s12904-019-0475-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/02/2019] [Indexed: 11/24/2022] Open
Abstract
Background “End of life” is a difficult topic of conversation in East Asian cultures, even among patients and doctors who share a good rapport. In 2016, the Hospice, Palliative Care, and Life-Sustaining Treatment Decision-Making Act, which took the form of “Physician Orders for Life-Sustaining Treatment,” was introduced in South Korea. This study was conducted to investigate the completion rate of Physician Orders for Life-Sustaining Treatment in patients with advanced cancer on the active recommendation of physicians, as well as patients’ general attitudes toward end-of-life care. Methods We conducted a preliminary, cross-sectional descriptive survey on patients with advanced cancer. A total of 101 patients with advanced solid cancer agreed to participate in the study. The primary endpoint was the rate of completion of Physician Orders for Life-Sustaining Treatment based on a doctor’s suggestion. Written interviews were conducted to understand the perceptions and factors influencing patients’ decisions. Results Of the 101 patients, 72 (71.3%) agreed to prepare Physician Orders for Life-Sustaining Treatment. Patients who had an educational level of high school or higher were more likely to agree to complete Physician Orders for Life-Sustaining Treatment documentation as compared to the lower educational status group. More than half of the respondents who completed Physician Orders for Life-Sustaining Treatment documentation reported that they had more than a fair understanding of “life-sustaining care” or “Physician Orders for Life-Sustaining Treatment.” Participants’ reasons for Physician Orders for Life-Sustaining Treatment completion were diverse. Conclusions We found that highly educated patients, who understood the concept behind the policy well, tended to accept Physician Orders for Life-Sustaining Treatment without hesitation. Better education, information shared through the media, and conversations with health care providers might improve understanding of Physician Orders for Life-Sustaining Treatment in patients with cancer.
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Affiliation(s)
- Ju Won Kim
- Division of Oncology/Hematology, Department of Internal medicine, Korea University Anam Hospital, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, South Korea
| | - Jung Yoon Choi
- Division of Oncology/Hematology, Department of Internal medicine, Korea University Anam Hospital, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, South Korea
| | - Won Jin Jang
- Division of Oncology/Hematology, Department of Internal medicine, Korea University Anam Hospital, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, South Korea
| | - Yoon Ji Choi
- Division of Oncology/Hematology, Department of Internal medicine, Korea University Anam Hospital, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, South Korea
| | - Youn Seon Choi
- Department of Family Medicine, Korea University Guro Hospital, 97 Guro-dong Gil, Guro-gu, Seoul, 08308, South Korea
| | - Sang Won Shin
- Division of Oncology/Hematology, Department of Internal medicine, Korea University Anam Hospital, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, South Korea
| | - Yeul Hong Kim
- Division of Oncology/Hematology, Department of Internal medicine, Korea University Anam Hospital, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, South Korea
| | - Kyong Hwa Park
- Division of Oncology/Hematology, Department of Internal medicine, Korea University Anam Hospital, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, South Korea.
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Wang AY, Chang CK. Do-not-attempt resuscitation independently predict in-hospital mortality in septic patients. Am J Emerg Med 2019; 38:953-957. [PMID: 31358382 DOI: 10.1016/j.ajem.2019.158362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/14/2019] [Accepted: 07/21/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Sepsis patients require timely and appropriate treatment in an intensive care setting. However, "do-not-attempt resuscitation" (DNAR) status may affect physicians' priorities and treatment preferences. The aim of this study was to evaluate whether DNAR status affects the outcomes of septic patients. METHODS This was a retrospective cohort study included septic patients admitted to the emergency department intensive care unit (ED-ICU) in a university-based teaching hospital during April-November 2015. Septic patients admitted to the ED-ICU were included. RESULTS Of the 132 eligible patients, 49.2% (65/132) had DNAR status (median age 80 years old, IQR, 73-86). The overall in-hospital mortality rate was 28.8% (38/132). Non-survivors had a higher percentage of receiving inotropes/vasopressors (52.6% vs 34.0%, p = 0.048), higher median Charlson comorbidity index scores [8.5 (IQR, 7-11.75) vs 8 (IQR, 6-9), p = 0.012], higher APACHE II score [25 (IQR, 20-30.25) vs 20 (IQR, 17-25), p = 0.002], and higher SOFA score [7 (IQR, 6-11) vs 6 (IQR,4-8), p = 0.012]. There was no significant difference in intubation among the two groups. In a multivariate logistic regression analysis, DNAR status was an independent predictor of in-hospital mortality (odds ratio = 6.22, 95% confidence interval (CI) = (2.71-17.88), p < 0.001). The area under the ROC curve for the logistic regression model was 0.84 [95% CI = (0.77-0.92), p < 0.001]. In subgroup analysis, DNAR status remained an independent predictor of mortality among age ≥65 years and ≥80 years. CONCLUSION After adjusting for comorbidities, treatments, and illness severity, DNAR status was associated with in-hospital mortality of septic patients. Further studies should evaluate physicians' attitudes toward septic patients with DNAR status.
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Affiliation(s)
- An-Yi Wang
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan; Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Cheng-Kuei Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan; Department of Neurosurgery, Shuang Ho Hospital, New-Taipei City, Taiwan.
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Nakagawa Y, Inokuchi S, Kobayashi N, Ohkubo Y. Do not attempt resuscitation order in Japan. Acute Med Surg 2017; 4:286-292. [PMID: 29123876 PMCID: PMC5674456 DOI: 10.1002/ams2.271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/30/2017] [Indexed: 11/24/2022] Open
Abstract
Aim In Japan, the do not attempt resuscitation (DNAR) order is practised routinely even though no related laws or guidelines exist. This study aimed to clarify the current status of DNAR, reveal existing DNAR‐related issues, and improve the application of DNAR. Methods A questionnaire survey of medical institutions in Kanagawa Prefecture (total population, 9,120,000) about the current status of DNAR was carried out. Results The results showed that DNAR has been practised at approximately 90% of the hospitals surveyed, but only about 30% have developed in‐hospital DNAR guidelines. Approximately 80% of the hospitals do not involve patients in the decision on their own DNAR orders. Because the DNAR order has not been legislated, it is often unclear whether to resuscitate patients when a request for an ambulance is made for a cardiac arrest at home. Conclusion It is necessary for prefectures, municipalities, and local medical control authorities to take the initiative in establishing an ordinance on DNAR orders and developing guidelines.
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Affiliation(s)
- Yoshihide Nakagawa
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Kanagawa Japan
| | - Sadaki Inokuchi
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Kanagawa Japan
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Chang HT, Lin MH, Chen CK, Chou P, Chen TJ, Hwang SJ. Trends of Do-Not-Resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: A Hospital-based observational study. Medicine (Baltimore) 2016; 95:e5394. [PMID: 27861375 PMCID: PMC5120932 DOI: 10.1097/md.0000000000005394] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital. Data on patients aged 20 years old or more who died of major terminal noncancer diseases, including brain diseases, amyotrophic lateral sclerosis, dementia, chronic obstructive pulmonary disease (COPD) and other lung diseases, heart failure, chronic liver diseases and cirrhosis, and renal failure between 2010 and 2014 were extracted for analysis. A total of 1416 patients aged 20 years or more died of major noncancer diseases in Taipei Veterans General Hospital during the study period. The most common diagnosis was brain diseases, amyotrophic lateral sclerosis, and dementias (n = 510, 36%) followed by chronic obstructive pulmonary disease and other lung diseases (n = 322, 22.7%). Among these noncancer decedents, 1045 (73.8%) had DNR consents, while 134 (9.5%) received hospice care. Patients diagnosed with renal failure had the highest percentage of DNR consent (80%), followed by chronic liver diseases and cirrhosis (77.7%). Patients diagnosed with chronic liver diseases and cirrhosis had the highest percentage of hospice utilization (17.4%), followed by renal failure (15.8%). The percentages of DNR consent and hospice utilization were significantly different across different disease diagnosis, hospitalization department, and year of death. There were increased trends of DNR consent in patients with major noncancer diagnoses, and increased hospice care utilization in patients diagnosed with lung diseases and renal failure from 2010 to 2014. However, the hospice care utilization could be improved. Further study to evaluate factors associated hospice care to improve the utilization is suggested.
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Affiliation(s)
- Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine and Institute of Public Health and Community Medicine Research Center, National Yang-Ming University
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine, and Institute of Public Health, National Yang-Ming University
| | - Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, National Yang-Ming University
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine and Institute of Hospital and Health Care Administration, National Yang-Ming University
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Liang YH, Wei CH, Hsu WH, Shao YY, Lin YC, Chou PC, Cheng AL, Yeh KH. Do-not-resuscitate consent signed by patients indicates a more favorable quality of end-of-life care for patients with advanced cancer. Support Care Cancer 2016; 25:533-539. [PMID: 27704261 DOI: 10.1007/s00520-016-3434-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/26/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Do-not-resuscitate (DNR) consent is crucial in end-of-life (EOL) care for patients with advanced cancer. However, DNR consents signed by patients (DNR-P) and surrogates (DNR-S) reflect differently on patient autonomy and awareness. METHODS This retrospective study enrolled advanced cancer patients treated at National Taiwan University Hospital, Hsin-Chu Branch between 2012 and 2014. Patients who signed DNR consent at other hospitals were excluded; the remaining patients were subsequently classified into DNR-S and DNR-P groups. RESULTS We enrolled 1495 patients. The most prevalent primary cancers were hepato-biliary-pancreatic (26.9 %), lung (16.3 %), and colorectal (14.0 %) cancers. We classified 965 (64.5 %) and 530 (35.5 %) patients into the DNR-S and DNR-P groups, respectively. Significant differences were observed between both groups regarding gender (p = 0.002), age (p < 0.001), and the Eastern Cooperative Oncology Group performance (p < 0.001) and educational (p < 0.001) status levels. The median survival times after DNR consent signature were 5.0 days (95 % confidence interval [CI] 4.4-5.6 days) and 14.0 days (95 % CI 12.1-15.9 days) in the DNR-S and DNR-P groups, respectively (p < 0.001). The median good death evaluation (GDE) scores were 5.4 (95 % CI 4.9-6.0) and 13.7 (95 % CI 12.7-14.6) in the DNR-S and DNR-P groups, respectively (p < 0.001). Univariate and multivariate analyses revealed that DNR-S was an independent factor for significantly low GDE scores (i.e., poor EOL care quality). CONCLUSION The DNR concept is emerging; however, the DNR-P percentage remains low (35.6 %) in patients with advanced cancer. DNR-P significantly improves the EOL care quality.
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Affiliation(s)
- Yi-Hsin Liang
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10002, Taiwan.,Department of Oncology, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan.,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Chih-Hsin Wei
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10002, Taiwan
| | - Wen-Hui Hsu
- Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Yu-Yun Shao
- Department of Oncology, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan.,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ya-Chin Lin
- Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Pei-Chun Chou
- Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan.,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan.,Department of Internal Medicine, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan.,Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan
| | - Kun-Huei Yeh
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10002, Taiwan. .,Department of Oncology, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan. .,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan. .,Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.
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Do-not-resuscitate orders and related factors among family surrogates of patients in the emergency department. Support Care Cancer 2015; 24:1999-2006. [DOI: 10.1007/s00520-015-2971-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/28/2015] [Indexed: 12/21/2022]
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