Palliative care model in Thailand

Identifying cancer patients who received palliative care using the SPICT-LIS in medical records: a rule-based algorithm and text-mining technique

BACKGROUND

Due to limited numbers of palliative care specialists and/or resources, accessing palliative care remains limited in many low and middle-income countries. Data science methods, such as rule-based algorithms and text mining, have potential to improve palliative care by facilitating analysis of electronic healthcare records. This study aimed to develop and evaluate a rule-based algorithm for identifying cancer patients who may benefit from palliative care based on the Thai version of the Supportive and Palliative Care Indicators for a Low-Income Setting (SPICT-LIS) criteria.

METHODS

The medical records of 14,363 cancer patients aged 18 years and older, diagnosed between 2016 and 2020 at Songklanagarind Hospital, were analyzed. Two rule-based algorithms, strict and relaxed, were designed to identify key SPICT-LIS indicators in the electronic medical records using tokenization and sentiment analysis. The inter-rater reliability between these two algorithms and palliative care physicians was assessed using percentage agreement and Cohen's kappa coefficient. Additionally, factors associated with patients might be given palliative care as they will benefit from it were examined.

RESULTS

The strict rule-based algorithm demonstrated a high degree of accuracy, with 95% agreement and Cohen's kappa coefficient of 0.83. In contrast, the relaxed rule-based algorithm demonstrated a lower agreement (71% agreement and Cohen's kappa of 0.16). Advanced-stage cancer with symptoms such as pain, dyspnea, edema, delirium, xerostomia, and anorexia were identified as significant predictors of potentially benefiting from palliative care.

CONCLUSION

The integration of rule-based algorithms with electronic medical records offers a promising method for enhancing the timely and accurate identification of patients with cancer might benefit from palliative care.

Palliative care programmes for people with conditions other than cancer in Thailand: a literature review

BACKGROUND

Thailand has few studies on palliative care programmes for people with conditions other than cancer.

OBJECTIVE

The objective of this review was to investigate and discuss existing studies of palliative care programmes for non-cancer patients in Thailand.

METHODS

A literature review was conducted using CINAHL, PubMed, Scopus, Science Direct and Google Scholar to find research conducted from 2000 to 2020. The search found 29 articles, eight of which met the inclusion criteria.

RESULTS

The eight articles included in this review were focused on four end-stage renal disease (ESRD) programmes, two congestive heart failure (CHF) programmes, one chronic obstructive pulmonary disease (COPD) programme and one stroke programme.

CONCLUSIONS

There have been few studies of existing palliative care programmes for non-cancer patients in Thailand. These programmes were developed for persons with ESRD, CHF, COPD and stroke, whereas none were available for people with dementia. More palliative care programmes are needed for non-cancer patients.