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Liu MF, Ho MH, Montayre J, Wang YW, Lin CC. Palliative Care Development in the Asia Pacific Region: A Review of Assessment Indicators. J Pain Symptom Manage 2021; 62:1008-1014. [PMID: 33933621 DOI: 10.1016/j.jpainsymman.2021.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 04/01/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022]
Abstract
CONTEXT Organizations such as Asia Pacific Hospice Palliative Care Network functions to promote quality palliative care development through training and education, research collaboration and variety relevant projects and events for all in the Asia and Pacific region. OBJECTIVES To summarise and further compare existing development indicators used in Asia Pacific region for palliative care. METHODS The current review used Whittemore and Knafl 's framework for integrative reviews. PubMed, Embase, CINAHL and Google Scholar databases were searched for eligible studies. This review focused on palliative care development according to the domains and indicators identified by the World Health Organization Public Health Strategy and ATLANTES Palliative Care Research Group. Joanna Briggs Institute critical appraisal checklists were adopted to assess the methodological quality of included studies. RESULTS Ten studies were included and two main findings were identified: 1) There was a strong evidence of educational preparation, use of medicines and service provision for palliative care development in Asia Pacific and 2) Professional activities and policy geared towards palliative care development were limited and had relative emphasis at a country-level in Asia Pacific. CONCLUSION Palliative care development is largely influenced by policies and funding structures as well as by cultural views and beliefs of stakeholders. It is expected that individuals, stakeholders and practitioners in Asia Pacific might have differing views and cultural beliefs when compared to the European or western counterparts. The lack of details and documentation in the region and inadequate reporting measures impacts on the development of strong palliative care framework.
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Affiliation(s)
| | - Mu-Hsing Ho
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Jed Montayre
- Western Sydney University, Penrith, New South Wales, Australia
| | - Ying-Wei Wang
- Tzu Chi University, Hualien, Taiwan; Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Chia-Chin Lin
- Taipei Medical University, Taipei, Taiwan; The University of Hong Kong, Pokfulam, Hong Kong.
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Huang YL, Yates P, Thorberg FA, Wu CJJ. Influence of social interactions, professional supports and fear of death on adults' preferences for life-sustaining treatments and palliative care. Int J Nurs Pract 2021; 28:e12940. [PMID: 33826202 DOI: 10.1111/ijn.12940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/26/2020] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Abstract
AIM To explore the significance of culture, professional support in the community, social interactions and intrapersonal determinants of adults' preferences for life-sustaining treatments and palliative care. METHODS A cross-sectional design with a Social Ecological Model was used. Between 1 October 2012 and 31 December 2012, 474 adults aged ≥20 years living in a city of Southern Taiwan completed the survey. Data were analysed using hierarchical multiple regression. RESULTS The life-sustaining measures model was significant with 15.3% (p < 0.0001) of the variance in the Modified Emmanuel Medical Directives being explained by variables of death of self and healthcare services' support. The palliative care model was significant with 18% (p < 0.0001) of the variance in the Modified Hospice Attitude Scale being explained by variables of palliative care knowledge, death of self and social interactions. However, cultural value adherence did not predict adults' preferences for life-sustaining measures and community resources support did not predict palliative care preference. CONCLUSIONS Findings enhance our understanding of the significance of different societal levels on adults' preferences for end-of-life care. Palliative care knowledge, fear of death, healthcare services' support and social interactions are essential factors that need to be taken into consideration when it comes to discussion about life-sustaining treatments and palliative care. SUMMARY STATEMENT What is already known about this topic? End-of-life (EOL) preferences can be shaped not just by knowledge, values and individuals' attitudes but rather a host of social influences. Few studies with theoretical frameworks or models in the literature are available to provide a comprehensive understanding of factors contributing to responses at the EOL. What this paper adds? The findings advance the knowledge of the influence of social interactions, healthcare services' support, palliative care understanding and fear of death on adults' preferences for life-sustaining treatments and palliative care. The identified relationships in the context of life-sustaining treatments and palliative care provide practical guidelines, which can help to inform appropriate supportive interventions for EOL care planning. The implications of this paper: Healthcare services that provide a mediating structure where a person belongs should focus on enhancing community resources regarding EOL healthcare planning, knowledge about palliative care and reinforcing life and death education. The social support network and emotional ties with a person's significant others should also be taken into consideration to facilitate EOL healthcare planning and to promote good quality of life at EOL.
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Affiliation(s)
- Ya-Ling Huang
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Department of Respiratory Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fred Arne Thorberg
- School of Psychology, Bond University, Gold Coast, Queensland, Australia.,School of Psychology and Counseling, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Chiung-Jung Jo Wu
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Petrie, Queensland, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Balante J, van den Broek D, White K. Mixed-methods systematic review: Cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care in the context of cancer. J Adv Nurs 2021; 77:3618-3629. [PMID: 33615526 DOI: 10.1111/jan.14814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
AIM To identify and analyse the cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care in the context of cancer. BACKGROUND Cultural heritage shape beliefs and practices about cancer and end of life, which complicates nursing care delivery. While previous studies centred on diverse patients' perspectives and cultural competence of healthcare professionals, little analysis available focusing on the cultural attitudes and beliefs of care providers from diverse backgrounds. DESIGN Mixed methods systematic review. DATA SOURCES CINAHL, MEDLINE, Embase, PsychINFO and Scopus were searched between January and March 2020. No date limit was applied. REVIEW METHODS Quality appraisal was conducted using the mixed-method appraisal tool. Convergent segregated synthesis was undertaken. Findings were thematically synthesised with the final synthesis presented narratively. RESULTS Seven studies were included: three qualitative, two quantitative and two mixed methods. None of the studies focused on the end-of-life care experiences of IENs in the context of cancer. One study reported views on cancer, with all studies analysing the cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care. Three main themes were identified: the philosophy of care, approaches to care and perceptions of death and dying. CONCLUSION The distinct gap in research on understanding the cultural attitudes and beliefs of internationally educated nurses in end-of-life care in the context of cancer demands further research. Several aspects of end-of-life care were in conflict with internationally educated nurses' cultural attitudes, beliefs and practices. As these nurses are integral in achieving culturally competent care, further understanding of this phenomenon is required to advance the delivery of culturally sensitive care to patients. IMPACT Stakeholders, including the nursing workforce, need to play an active role in providing a culturally inclusive workplace. Support measures are necessary to reduce the impact of cultural conflicts experienced by internationally educated nurses.
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Affiliation(s)
- Jay Balante
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Diane van den Broek
- Discipline of Work and Organisational Studies, Business School, The University of Sydney, Darlington, NSW, Australia
| | - Kate White
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Fayyazi Bordbar MR, Tavakkoli K, Nahidi M, Fayyazi Bordbar A. Investigating the Attitude of Healthcare Providers, Patients, and Their Families toward "Do Not Resuscitate" Orders in an Iranian Oncology Hospital. Indian J Palliat Care 2019; 25:440-444. [PMID: 31413462 PMCID: PMC6659519 DOI: 10.4103/ijpc.ijpc_29_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim The decision-making process for do-not-resuscitate (DNR) order has always been challenging. Cultural and religious issues have limited the issuance and execution of DNR orders in Iran. The purpose of this study was to assess the attitude of the nurses, physicians, patients, and their families toward the DNR order. Subjects and Methods In this cross-sectional study, 343 participants (201 patients, 95 family members, and 47 healthcare providers) from Omid Oncology Hospital, Mashhad, Iran, were surveyed during 2017-2018. All the participants were asked to fill in a checklist of demographic information and a validated questionnaire about their attitude toward DNR orders after giving consent. The data were analyzed using SPSS software and values of P < 0.05 were considered statistically significant. Results Overall, 201 patients and 95 of their family members, as well as 47 healthcare providers (doctors and nurses), were surveyed. The mean age of participants was 48.75 ± 15.62 years. The attitude of the participants regarding the DNR order was significantly different in 10 of the 11 items (P ≤ 0.005). Among the three groups of participants, healthcare providers showed the most positive attitude regarding the DNR order. The attitude of participants regarding the DNR orders was significantly associated with age, occupation status, residential place, educational status, and income level (P < 0.05). Conclusions Various factors, such as economic status, level of education, place of residence, and gender, can be effective on decision-making regarding the DNR orders. Unified and sustained education regarding moral and cultural issues can be helpful in the reconciliation of the attitudes between caregivers and patients.
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Affiliation(s)
| | - Keyvan Tavakkoli
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Nahidi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Fayyazi Bordbar
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
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The Challenges, Emotions, Coping, and Gains of Family Caregivers Caring for Patients With Advanced Cancer in Singapore. Cancer Nurs 2017; 40:22-30. [DOI: 10.1097/ncc.0000000000000354] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wang X, Huang Y, Radha Krishna L, Puvanendran R. Role of the Nasogastric Tube and Lingzhi (Ganoderma lucidum) in Palliative Care. J Pain Symptom Manage 2016; 51:794-799. [PMID: 26891608 DOI: 10.1016/j.jpainsymman.2015.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 11/23/2015] [Accepted: 11/27/2015] [Indexed: 11/17/2022]
Abstract
Decision-making on behalf of an incapacitated patient at the end of life is a complex process, particularly in family-centric societies. The situation is more complex when attempts are made to accommodate Eastern concepts of end-of-life care with more conventional Western approaches. In this case report of an incapacitated 74-year-old Singaporean man of Malay descent with relapsed Stage 4 diffuse large B cell lymphoma who was without an established lasting power of attorney, we highlight the difficult deliberations that ensue when the patient's family, acting as his proxy, elected to administer lingzhi through his nasogastric tube (NGT). Focusing on the questions pertaining to end-of-life decision-making in Asia, we consider the issues surrounding the use of NGT and lingzhi in palliative care (PC) and the implementation of NGT for administering lingzhi in a PC setting, particularly in light of a dearth of data on such treatment measures among PC patients.
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Affiliation(s)
- Xiaohui Wang
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Youyi Huang
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Lalit Radha Krishna
- Duke-NUS Graduate Medical School, Singapore, Singapore; National Cancer Centre, Singapore, Singapore
| | - Rukshini Puvanendran
- Duke-NUS Graduate Medical School, Singapore, Singapore; KK Women's and Children's Hospital, Singapore, Singapore.
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McCarthy SA, Jenn NC, Leng CCK, Hamzah E. What are the experiences and needs of patients and carers receiving community palliative care in Malaysia? A qualitative study. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1179/1743291x14y.0000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Heidenreich MT, Koo FK, White K. The experience of Chinese immigrant women in caring for a terminally ill family member in Australia. Collegian 2015; 21:275-85. [PMID: 25632724 DOI: 10.1016/j.colegn.2013.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Chinese community, a heterogeneous, highly visible non-English speaking ethnic group in Australia, remains mostly hidden and underrepresented in palliative care service delivery along with participation in health research despite being the fastest growing such group in the country. There is a lack of Australian research information concerning the impact of migration on the caregiving experience of women carers within the Chinese cultural framework and the Australian palliative care context. This paper aims to explore the influence of Chinese cultural norms and immigration on the experience of immigrant women of Chinese ancestry caring for a terminally ill family member at home in Sydney. This study also seeks to identify factors that may present access barriers to palliative care support services. A qualitative approach was used in this study. Data were collected from semi-structured interviews with five home-based Chinese women carers and were analysed using thematic analysis. Findings identified that the participants found being a carer is a lonely and isolating experience. Sources of isolation and loneliness included social isolation experienced as a solitary carer without meaningful family and social relationships; loss of familiar cultural understandings and family values; and emotional isolators expressed in response to the physical and emotional role commitment and other constraints. The study results suggest the need for palliative care educational programmes designed to help nurses to understand the impact of cultural background within the palliative care context. Results also indicate that health care professionals should provide culturally appropriate and competent palliative care services, sensitive to the diverse socio-cultural influences and individual needs of Chinese migrants.
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Kudla D, Kujur J, Tigga S, Tirkey P, Rai P, Fegg MJ. Meaning in life experience at the end of life: validation of the Hindi version of the Schedule for Meaning in Life Evaluation and a cross-cultural comparison between Indian and German palliative care patients. J Pain Symptom Manage 2015; 49:79-88. [PMID: 24937164 DOI: 10.1016/j.jpainsymman.2014.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/28/2014] [Accepted: 05/16/2014] [Indexed: 12/12/2022]
Abstract
CONTEXT The experience of Meaning in Life (MiL) is a major protective factor against feelings of hopelessness and wishes for hastened death in palliative care (PC) patients. However, most instruments for MiL assessment have been developed only in Western countries so far. Little is known about MiL experience in Asian PC patients. OBJECTIVES This study aimed to provide a Hindi version of the Schedule for Meaning in Life Evaluation (SMiLE), test its feasibility and validity in Indian PC patients, and compare the results with previous studies in Germany. METHODS Indian PC patients in a hospice for the destitute were eligible to participate in this cross-sectional study. In the SMiLE instrument, respondents individually listed MiL-giving areas before rating their satisfaction with and importance of these areas. Overall indices of satisfaction (IoS, range 0-100), weighting (IoW, range 0-100), and weighted satisfaction (IoWS, range 0-100) were calculated. RESULTS A Hindi forward-backward translation of the SMiLE was made. Two hundred fifty-eight Indian PC patients took part in the study (response rate 93.5%). Convergent validity of the SMiLE was found with the World Health Organization Quality of Life-Brief version (r = 0.17; P = 0.008) and the Idler Index of Religiosity (public religiousness: r = 0.25, P < 0.001 and private religiousness: r = 0.29, P < 0.001). Indian PC patients' IoW was 65.8 ± 22.1, IoS 68.6 ± 17.4, and IoWS 70.2 ± 17.0. In multivariate analyses of covariance, they differed significantly from German PC patients only in IoW (IoW: 84.8 ± 11.5, P < 0.001; IoS: 70.2 ± 19.7; IoWS: 72.0 ± 19.4). Compared with Germans, Indians more often listed spirituality (P < 0.001) and social commitment (P < 0.001) and less often social relations (P = 0.008). CONCLUSION Preliminary results indicate good feasibility and validity of the Hindi version of the SMiLE. MiL experience also seems to be a coping resource for Indian PC patients.
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Affiliation(s)
- Dorothea Kudla
- Department of Palliative Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Julius Kujur
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Sumanti Tigga
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Prakash Tirkey
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Punita Rai
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Martin Johannes Fegg
- Department of Palliative Medicine, Ludwig-Maximilians-University, Munich, Germany.
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Mogadasian S, Abdollahzadeh F, Rahmani A, Ferguson C, Pakanzad F, Pakpour V, Heidarzadeh H. The attitude of Iranian nurses about do not resuscitate orders. Indian J Palliat Care 2014; 20:21-5. [PMID: 24600178 PMCID: PMC3931237 DOI: 10.4103/0973-1075.125550] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Do not resuscitate (DNR) orders are one of many challenging issues in end of life care. Previous research has not investigated Muslim nurses’ attitudes towards DNR orders. Aims: This study aims to investigate the attitude of Iranian nurses towards DNR orders and determine the role of religious sects in forming attitudes. Materials and Methods: In this descriptive-comparative study, 306 nurses from five hospitals affiliated to Tabriz University of Medical Sciences (TUOMS) in East Azerbaijan Province and three hospitals in Kurdistan province participated. Data were gathered by a survey design on attitudes on DNR orders. Data were analyzed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL) software examining descriptive and inferential statistics. Results: Participants showed their willingness to learn more about DNR orders and highlights the importance of respecting patients and their families in DNR orders. In contrast, in many key items participants reported their negative attitude towards DNR orders. There were statistical differences in two items between the attitude of Shiite and Sunni nurses. Conclusions: Iranian nurses, regardless of their religious sects, reported negative attitude towards many aspects of DNR orders. It may be possible to change the attitude of Iranian nurses towards DNR through education.
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Affiliation(s)
- Sima Mogadasian
- Department of Medical-Surgical, Faculty of Nursing and Midwifery, Tabriz, Iran
| | | | - Azad Rahmani
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Caleb Ferguson
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Australia
| | - Fermisk Pakanzad
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Pakpour
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Heidarzadeh
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Lin YH, Chen YC, Tseng YH, Lin MH, Hwang SJ, Chen TJ, Chou LF. Trend of urban-rural disparities in hospice utilization in Taiwan. PLoS One 2013; 8:e62492. [PMID: 23658633 PMCID: PMC3637250 DOI: 10.1371/journal.pone.0062492] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 03/22/2013] [Indexed: 11/18/2022] Open
Abstract
AIMS The palliative care has spread rapidly worldwide in the recent two decades. The development of hospice services in rural areas usually lags behind that in urban areas. The aim of our study was to investigate whether the urban-rural disparity widens in a country with a hospital-based hospice system. METHODS From the nationwide claims database within the National Health Insurance in Taiwan, admissions to hospices from 2000 to 2006 were identified. Hospices and patients in each year were analyzed according to geographic location and residence. RESULTS A total of 26,292 cancer patients had been admitted to hospices. The proportion of rural patients to all patients increased with time from 17.8% in 2000 to 25.7% in 2006. Although the numbers of beds and the utilizations in both urban and rural hospices expanded rapidly, the increasing trend in rural areas was more marked than that in urban areas. However, still two-thirds (898/1,357) of rural patients were admitted to urban hospices in 2006. CONCLUSIONS The gap of hospice utilizations between urban and rural areas in Taiwan did not widen with time. There was room for improvement in sufficient supply of rural hospices or efficient referral of rural patients.
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Affiliation(s)
- Yi-Hsuan Lin
- Department of Family Medicine, Kaohsiung Veterans General Hospital Pingtung Branch, Pingtung, Taiwan
| | - Yi-Chun Chen
- Department of Family Medicine, Taitung Veterans Hospital, Taitung, Taiwan
| | - Yen-Han Tseng
- Respiratory Therapy Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan
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Payne S, Chan N, Davies A, Poon E, Connor S, Goh C. Supportive, palliative, and end-of-life care for patients with cancer in Asia: resource-stratified guidelines from the Asian Oncology Summit 2012. Lancet Oncol 2013; 13:e492-500. [PMID: 23117004 DOI: 10.1016/s1470-2045(12)70380-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The burden of cancer in Asia is high; 6·1 million new cases were diagnosed in the continent in 2008, which accounted for 48% of new cases worldwide. Deaths from cancer are expected to continue to rise because of ageing populations and modifiable risk factors such as tobacco and alcohol use, diet, and obesity. Most patients who are diagnosed with cancer in Asia have advanced disease that is not amenable to curative treatment, which means that they are likely to have pain and other symptoms and psychosocial concerns. These burdens vary with the economic and political situation of the different countries and are affected by such factors as an absence of screening programmes, insufficient cancer diagnostic and treatment services (especially in sparsely populated and rural areas), legal restrictions on access to drugs to relieve pain, and a medical culture in which quality-of-life considerations are undervalued in relation to imperatives to treat. These issues could be ameliorated by increased investment in cancer screening, removal of restrictions on prescription of opioids, and improvements in medical education to increase recognition of treatment futility. Supportive, palliative, and end-of-life care offer the potential to enhance quality of life, improve pain control, and reduce suffering for patients with cancer and their families, and to give patients a dignified death. All patients should have access to such care-in resource-rich regions these services should be integrated into oncology services, whereas in resource-poor regions they should be the main focus of treatment. The form of care should depend on the economic circumstances within and across countries, and recommendations are made across four resource classifications (basic to maximal) to take account of the diversity of settings in Asia.
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Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
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Bloomer MJ, Cross W, Endacott R, O'Connor M, Moss C. Qualitative observation in a clinical setting: Challenges at end of life. Nurs Health Sci 2012; 14:25-31. [DOI: 10.1111/j.1442-2018.2011.00653.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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