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Huang HW, Liu CY, Tung TH, Liu LN. Effects of hospice-shared care on terminal cancer patients in Taiwan: A hospital-based observational study. Eur J Oncol Nurs 2024; 69:102525. [PMID: 38340644 DOI: 10.1016/j.ejon.2024.102525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To assess how hospice-shared care (HSC) affected the likelihood of aggressive medical treatments and the life quality among terminal cancer patients. METHODS In the first part, a cohort of 160 late-stage cancer patients who died in non-hospice wards were identified to review their charts in their last 22 days before death. In the second part, a total of 19 late-stage cancer patients with clear consciousness admitted to non-hospice wards were identified to investigate their quality of life for the final 2 weeks before death. RESULTS The utilization rate of HSC was 55.6%. Among these, the rate for late referral to HSC (≤7 days before death) was 43.8% and early referral (>3 months before death) was 5.6%. Compared to the non-HSC group, in the last few weeks of life, the HSC group underwent lower incidence of chemotherapy use (10.1% vs. 39.4%, p < .001), signed do-not-resuscitate orders (0% vs. 21.1%, p < .001), emergency room visits (13.5% vs. 40.8%, p < .001), intensive care unit admission or ventilator use (2.2% vs. 11.3%, p = .019), and endotracheal intubation (2.2% vs. 9.9%, p = .038). However, the quality of life did not appear to have obvious differences between the two groups (p > .05). CONCLUSION In Taiwan, late HSC referral in terminal cancer patients is common. HSC is associated with a reduced likelihood of aggressive medical utilization. However, the effect of HSC in improving patients' quality of life in the last few weeks needs to be further evaluated.
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Affiliation(s)
- Hui-Wen Huang
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Yu Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan; Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Li-Ni Liu
- Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan.
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Selvakumaran K, Sleeman KE, Davies JM. How good are we at reporting the socioeconomic position, ethnicity, race, religion and main language of research participants? A review of the quality of reporting in palliative care intervention studies. Palliat Med 2024; 38:396-399. [PMID: 38331779 PMCID: PMC10955797 DOI: 10.1177/02692163231224154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
| | - Katherine E Sleeman
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
| | - Joanna M Davies
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
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Yu TH, Lu FL, Wei CJ, Wu WW. The impacts of the scope of benefits expansion on hospice care among adult decedents: a nationwide longitudinal observational study. BMC Palliat Care 2023; 22:29. [PMID: 36978057 PMCID: PMC10053103 DOI: 10.1186/s12904-023-01146-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVES Compared to aggressive treatment for patients at the end stage of life, hospice care might be more likely to satisfy such patients' need and benefits and improve their dignity and quality of life. Whether the reimbursement policy expansion affect the use of hospice care among various demographics characteristics and health status was unknown. Therefore, the purpose of this study was to explore the impacts of reimbursement policy expansion on hospice care use, and to investigate the effects on people with various demographics characteristics and health status. METHODS We used the 2001-2017 Taiwan NHI claims data, Death Registry, and Cancer Registry in this study, and we included people who died between 2002 and 2017. The study period was divided into 4 sub-periods. hospice care use and the initiation time of 1st hospice care use were used as dependent variables; demographic characteristics and health status were also collected. RESULTS There were 2,445,781 people who died in Taiwan during the study period. The results show that the trend of hospice care use increased over time, going steeply upward after the scope of benefits expansion, but the initiation time of 1st hospice care use did not increase after the scope of benefits expansion. The results also show that the effects of expansion varied among patients by demographic characteristics. CONCLUSION The scope of benefits expansion might induce people's needs in hospice care, but the effects varied by demographic characteristics. Understanding the reasons for the variations in all populations would be the next step for Taiwan's health authorities.
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Affiliation(s)
- Tsung-Hsien Yu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Frank Leigh Lu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
- School of Medicine, National Taiwan University, No.1 Jen-Ai Road section 1 Taipei 100, Taipei, Taiwan
| | - Chung-Jen Wei
- Department of Public Health, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Wei-Wen Wu
- School of Medicine, National Taiwan University, No.1 Jen-Ai Road section 1 Taipei 100, Taipei, Taiwan.
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
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Chen CL, Wang ST, Cheng WC, Wu BR, Liao WC, Hsu WH. Outcomes and Prognostic Factors in Critical Patients with Hematologic Malignancies. J Clin Med 2023; 12:jcm12030958. [PMID: 36769606 PMCID: PMC9918099 DOI: 10.3390/jcm12030958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Patients with hematologic malignancies (HMs) have a significantly elevated risk of mortality compared to other cancer patients treated in the intensive care unit (ICU). The prognostic impact of numerous poor outcome indicators has changed, and research has yielded conflicting results. This study aims to determine the ICU and hospital outcomes and risk factors that predict the prognosis of critically ill patients with HMs. In this retrospective study, conducted at a referral hospital in Taiwan, 213 adult patients with HMs who were admitted to the medical ICU were evaluated. We collected clinical data upon hospital and ICU admission. Using a multivariate regression analysis, the predictors of ICU and hospital mortality were assessed. Then, a scoring system (Hospital outcome of critically ill patients with Hematological Malignancies (HHM)) was built to predict hospital outcomes. Most HMs (76.1%) were classified as high grade, and more than one-third of patients experienced a relapsed or refractory disease. The ICU and hospital mortality rates were 55.9% and 71.8%, respectively. Moreover, the disease severity was high (median Sequential Organ Failure Assessment (SOFA) score: 11 and Acute Physiology and Chronic Health Evaluation (APACHE II) score: 28). The multivariate analysis revealed that high-grade HMs, invasive mechanical ventilation requirement, renal replacement therapy initiation in the ICU, and a high SOFA score correlated with ICU mortality. Furthermore, a higher HHM score predicted hospital mortality. This study demonstrates that ICU mortality primarily correlates with the severity of organ dysfunction, whereas the disease status markedly influences hospital outcomes. Furthermore, the HHM score significantly predicts hospital mortality.
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Affiliation(s)
- Chieh-Lung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
| | - Sing-Ting Wang
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
| | - Wen-Chien Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Life Science, National Chung Hsing University, Taichung 402, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Biing-Ru Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
- Department of Respiratory Therapy, China Medical University Hospital, Taichung 404, Taiwan
- Correspondence: (B.-R.W.); (W.-C.L.)
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
- Center for Hyperbaric Oxygenation Therapy, China Medical University Hospital, Taichung 404, Taiwan
- Correspondence: (B.-R.W.); (W.-C.L.)
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
- Critical Medical Center, China Medical University Hospital, Taichung 404, Taiwan
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5
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What are the outcomes of hospice care for cancer patients? A systematic review. Support Care Cancer 2023; 31:64. [DOI: 10.1007/s00520-022-07524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/12/2022] [Indexed: 12/24/2022]
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Wang CL, Lin CY, Yang SF. Hospice Care Improves Patients' Self-Decision Making and Reduces Aggressiveness of End-of-Life Care for Advanced Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15593. [PMID: 36497668 PMCID: PMC9735887 DOI: 10.3390/ijerph192315593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The aim of the current study is to evaluate the different degrees of hospice care in improving patients' autonomy in decision-making and reducing aggressiveness of cancer care in terminal-stage cancer patients, especially in reducing polypharmacy and excessive life-sustaining treatments. This was a retrospective cross-sectional study conducted in a single medical center in Taiwan. Patients with advanced cancer who died in 2010-2019 were included and classified into three subgroups: hospice ward admission, hospice shared care, and no hospice care involvement. In total, 8719 patients were enrolled, and 2097 (24.05%) admitted to hospice ward; 2107 (24.17%) received hospice shared care, and 4515 (51.78%) had no hospice care. Those admitted to hospice ward had significantly higher rates of having completed do-not-resuscitate order (100%, p < 0.001) and signed the do-not-resuscitate order by themselves (48.83%, p < 0.001), and they had lower aggressiveness of cancer care (2.2, p < 0.001) within the 28 days before death. Hospice ward admission, hospice shared care, and age > 79 years were negatively associated with aggressiveness of cancer care. In conclusion, our study showed that patients with end-of-life hospice care related to higher patient autonomy in decision-making and less excessively aggressive cancer care; the influence of care was more overt in patients approaching death. Further clinical efforts should be made to clarify the patient and the families' satisfaction and perceptions of quality after hospice care involvement.
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Affiliation(s)
- Chun-Li Wang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chia-Yen Lin
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
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7
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Optimal timing for hospice-shared care initiation in terminal cancer patients. Support Care Cancer 2021; 29:6871-6880. [PMID: 34014407 DOI: 10.1007/s00520-021-06284-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The existing concept suggests early palliative and hospice therapy for a better quality of care (QOC) and less medical expense in terminal cancer patients, but the time points of "early" initiation were defined by pre-set study protocol rather than the real-world data. The study aimed to determine the optimal timing of initiating palliative care for patients with terminal cancer. METHODS This retrospective population-based study was conducted using a nationwide database. We extracted patients with cancer who were in their last year of lives in the period from 1 January 2010 to 31 December 2013 and categorized them into two groups ("hospice-shared care" (HSC) group and "usual care" (UC) group) after a matching process. Subsequently, we used a generalized linear mixed-effects model to compare the QOC and medical expenses between groups. RESULTS After the selection and matching process, we enrolled 1714 patients (67.7 ± 13.2 years, 62.7% male) categorized into the HSC and UC groups (n = 857 in each group). The HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8-60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15-90 days before death. CONCLUSIONS Among patients with terminal cancer, HSC initiation before the last 8 days and 15 days of lives can effectively improve QOC and save medical expenses, respectively.
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Kim D, Yoo SH, Seo S, Lee HJ, Kim MS, Shin SJ, Lim CY, Kim DY, Heo DS, Lim CM. Analysis of Cancer Patient Decision-making and Health Service Utilization after Enforcement of the Life-Sustaining Treatment Decision-Making Act in Korea. Cancer Res Treat 2021; 54:20-29. [PMID: 33848413 PMCID: PMC8756111 DOI: 10.4143/crt.2021.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/09/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to confirm the decision-making patterns for life-sustaining treatment (LST) and analyze medical service utilization changes after enforcement of the Life-Sustaining Treatment Decision-Making Act. Materials and Methods Of 1,237 patients who completed legal forms for life-sustaining treatment (hereafter called the LST form) at three academic hospitals and died at the same institutions, 1,018 cancer patients were included. Medical service utilization and costs were analyzed using claims data. Results The median time to death from completion of the LST form was three days (range, 0 to 248 days). Of these, 517 people died within two days of completing the document, and 36.1% of all patients prepared the LST form themselves. The frequency of use of the intensive care unit, continuous renal replacement therapy, and mechanical ventilation was significantly higher when the families filled out the form without knowing the patient’s intention. In the top 10% of the medical expense groups, the decision-makers for LST were family members rather than patients (28% patients vs. 32% family members who knew and 40% family members who did not know the patient’s intention). Conclusion The cancer patient’s own decision-making rather than the family’s decision was associated with earlier decision-making, less use of some critical treatments (except chemotherapy) and expensive evaluations, and a trend toward lower medical costs.
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Affiliation(s)
- Dalyong Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Seyoung Seo
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Min Sun Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Chi-Yeon Lim
- Department of Biostatistics, Dongguk University College of Medicine, Goyang, Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Dae Seog Heo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yen YF, Lai YJ, Ko MC, Chen YY, Chen YT, Chou YS, Huang CT, Chen CC. Association of Hospice Care Services With the Utilization of Life-Sustaining Treatments During End-of-Life Care Among Patients With Cancer: A Nationwide 11-Year Cohort Study. J Pain Symptom Manage 2021; 61:323-330. [PMID: 32739560 DOI: 10.1016/j.jpainsymman.2020.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT The impact of hospice care services on the utilization of life-sustaining treatments during end-of-life care in terminally ill patients has not been extensively studied. OBJECTIVES To determine the impact of hospice care services on the utilization of life-sustaining treatments during the last three months of life among patients with cancer. METHODS This nationwide population-based cohort study identified adults with cancer diagnosis from the Taiwan Registry for Catastrophic Illness, 2006-2016. Life-sustaining treatments included cardiopulmonary resuscitation, intubation, mechanical ventilation support, nasogastric tube feeding, and total parenteral nutrition. Hospice care services consisted of hospice inpatient care, hospice-shared care, and hospice home care. The association of hospice care services with the utilization of life-sustaining treatments was determined using multiple logistic regression. RESULTS Of 516,409 patients with cancer, 310,722 (60.2%) patients used life-sustaining treatments during the last three months of life. After adjusting for covariates, patients with hospice care services were less likely to receive life-sustaining treatments during the last three months of life than those without the services (adjusted odds ratio [AOR]: 0.70; 95% CI: 0.69-0.71). While type of life-sustaining treatments were considered, hospice care services were associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR: 0.125; 95% CI: 0.118-0.131), endotracheal intubation (AOR: 0.204; 95% CI: 0.199-0.210), mechanical ventilation support (AOR: 0.265; 95% CI: 0.260-0.270), nasogastric tube feeding (AOR: 0.736; 95% CI: 0.727-0.744), and total parenteral nutrition (AOR: 0.86; 95% CI: 0.84-0.88). CONCLUSION Hospice care services were associated with a lower likelihood of receiving life-sustaining treatments during the last three months of life in patients with cancer.
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Affiliation(s)
- Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taiwan.
| | - Yun-Ju Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan; Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Ming-Chung Ko
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Department of Urology, Taipei City Hospital, Taipei, Taiwan
| | - Yu-Yen Chen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Tui Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yi-Sheng Chou
- Department of Hematology and Oncology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Chun-Teng Huang
- Department of Hematology and Oncology, Taipei City Hospital, Yang-Ming Branch, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Wang SC, Hu KC, Chang WC, Hsu CY. Utilization of hospice and nonhospice care in patients with end-stage renal disease on dialysis. Tzu Chi Med J 2021; 34:232-238. [PMID: 35465279 PMCID: PMC9020240 DOI: 10.4103/tcmj.tcmj_207_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/30/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: The prevalence of end-stage renal disease (ESRD) and the number of patients undergoing dialysis in Taiwan are high. Since September 2009, the National Health Insurance has started to provide hospice care to patients with renal failure in Taiwan. Therefore, it is necessary to understand the use of hospice and nonhospice care in patients with ESRD on dialysis. We aim to understand trends in patients with ESRD receiving hospice and nonhospice care as well as medical care efforts during the last month of their lives (2009–2013). Materials and Methods: The cohort study was conducted using 1 million randomly selected samples from the Taiwan Health Insurance Research Database for millions of people in Taiwan in 2009–2013. Descriptive statistics were presented to summarize the characteristics of data. To compare differences between cohorts, Chi-square tests and Student's t-tests were used. Mann–Whitney U-tests were performed for nonnormally distributed data. Mantel–Haenszel test was test for trend. Results: We recruited 770 ESRD patients who underwent hemodialysis; among them, 154 patients received hospice care. Patients who received hospice care had a significantly longer survival time after removal of mechanical ventilator (20 vs. 0 days) and after discontinuation of dialysis (2 vs. 0 days) compared with those who did not receive hospice care. Patients who received hospice care had more pain control (61.04% vs. 17.37%, P < 0.0001) and other symptomatic control (55.84% vs. 43.18% with diuretics, P < 0.05; 64.29% and 48.21% with laxatives, P = 0.0004) medications than those who did not. Nevertheless, the overall medical cost in the hospice group was significantly lower (90 USD and 280 USD, P < 0.0001). Conclusion: Our results suggest that the addition of hospice care may permit patients a longer life-support-free survival time. In addition, despite a more frequent symptomatic controlling agent use, hospice care significantly reduced the overall medical expenditure.
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Lin CY, Lee YC. Choosing and Doing wisely: triage level I resuscitation a possible new field for starting palliative care and avoiding low-value care - a nationwide matched-pair retrospective cohort study in Taiwan. BMC Palliat Care 2020; 19:87. [PMID: 32563245 PMCID: PMC7305586 DOI: 10.1186/s12904-020-00590-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The association between palliative care and life-sustaining treatment following emergency department (ED) resuscitation is unclear. This study aims to analyze the usage of palliative care and life-sustaining treatments among ED triage level I resuscitation patients based on a nationally representative sample of patients in Taiwan. METHODS A matched-pair retrospective cohort study was conducted to examine the association between palliative care and outcome variables using multivariate logistic regression and Kaplan-Meier survival analyses. Between 2009 and 2013, 336 ED triage level I resuscitation patients received palliative care services (palliative care group) under a universal health insurance scheme. Retrospective cohort matching was performed with those who received standard care at a ratio of 1:4 (usual care group). Outcome variables included the number of visits to emergency and outpatient departments, hospitalization duration, total medical expenses, utilization of life-sustaining treatments, and duration of survival following ED triage level I resuscitation. RESULTS The mean survival duration following level I resuscitation was less than 1 year. Palliative care was administered to 15% of the resuscitation cohort. The palliative care group received significantly less life-sustaining treatment than did the usual care group. CONCLUSION Among patients who underwent level I resuscitation, palliative care was inversely correlated with the scope of life-sustaining treatments. Furthermore, triage level I resuscitation status may present a possible new field for starting palliative care intervention and reducing low-value care.
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Affiliation(s)
- Chih-Yuan Lin
- Department of Neurology, Taipei City Hospital, Taipei, Taiwan
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health, Taipei, Taiwan
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Master Program on Trans-disciplinary Long-Term Care and Management, National Yang-Ming University, Taipei, Taiwan
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12
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Huang YT, Wang YW, Chi CW, Hu WY, Lin R, Shiao CC, Tang WR. Differences in medical costs for end-of-life patients receiving traditional care and those receiving hospice care: A retrospective study. PLoS One 2020; 15:e0229176. [PMID: 32078660 PMCID: PMC7032706 DOI: 10.1371/journal.pone.0229176] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 02/02/2020] [Indexed: 12/20/2022] Open
Abstract
Background Hospice care has a positive effect on medical costs. The correlation between survival time after receiving hospice care and medical costs has not been previously investigated in the literature on Taiwan. This study aimed to compare the differences in medical costs between traditional care and hospice care among end-of-life patients with cancer. Methods Data from Taiwan’s National Health Insurance program on all patients who had passed away between 2010 and 2013 were used. Those whose year of death was between 2010 and 2013 were defined as end-of-life patients. The patients were divided into two groups: traditional care and hospice care. We then analyzed the differences in end-of-life medical cost between the two groups. Results From 2010 to 2013, the proportion of patients receiving hospice care significantly increased from 22.2% to 41.30%. In the hospice group, compared with the traditional group, the proportions of hospital stays over 14 days and deaths in a hospital were significantly higher, but the proportions of outpatient clinic visits; emergency room admissions; intensive care unit admissions; use of ventilator; use of cardiopulmonary resuscitation; and use of hemodialysis, surgery, and chemotherapy were significantly lower. Total medical costs were significantly lower. A greater number of days of survival for end-of-life patients when receiving hospice care results in higher saved medical costs. Conclusion Hospice care can effectively save a large amount of end-of-life medical costs, and more medical costs are saved when patients are referred to hospice care earlier.
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Affiliation(s)
- Ya-Ting Huang
- Department of Nursing, Camillian Saint Mary`s Hospital Luodong, Luodong, Yilan, Taiwan, R.O.C.,Saint Mary's Junior College of Medicine, Nursing and Management, Sanxing Township, Taiwan, R.O.C
| | - Ying-Wei Wang
- Health Promotion Administration, Ministry of Health and Welfare. Datong Dist., Taipei City, Taiwan, R.O.C
| | - Chou-Wen Chi
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan Dist., Taoyuan City, Taiwan, R.O.C.,College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Wen-Yu Hu
- Department of Nursing College of Medicine, National Taiwan University, Taipei, Taiwan R.O.C
| | - Rung Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Guishan Dist., Taoyuan City, Taiwan, R.O.C.,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC.,Graduate Institute of Clinical Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Chih-Chung Shiao
- Saint Mary's Junior College of Medicine, Nursing and Management, Sanxing Township, Taiwan, R.O.C.,Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary`s Hospital Luodong, Luodong, Yilan, Taiwan, R.O.C
| | - Woung-Ru Tang
- School of Nursing, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
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Abedini NC, Hechtman RK, Singh AD, Khateeb R, Mann J, Townsend W, Chopra V. Interventions to reduce aggressive care at end of life among patients with cancer: a systematic review. Lancet Oncol 2019; 20:e627-e636. [DOI: 10.1016/s1470-2045(19)30496-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 01/17/2023]
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Kuo LC, Lee JJ, Cheung DST, Chen PJ, Lin CC. End-of-life care in cancer and dementia: a nationwide population-based study of palliative care policy changes. BMJ Support Palliat Care 2019; 12:bmjspcare-2019-001782. [PMID: 31530554 DOI: 10.1136/bmjspcare-2019-001782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 08/13/2019] [Accepted: 08/21/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The National Health Insurance programme started providing coverage for inpatient care in palliative care (PC) units of acute care hospitals in 2000; however, initially, only PC provided to patients with terminal cancer was covered. A PC policy that enabled PC reimbursement for patients with dementia was implemented in 2009. However, the association of this PC policy with end-of-life care remains unclear. The study aims to compare the association of the PC policy with end-of-life care between patients with dementia and patients with cancer during the last 6 months of their lives. METHODS We analysed the claims data of 7396 patients dying with dementia (PDD) and 24 319 patients dying with cancer (PDC) during 1997-2013. RESULTS Among PDC, while the percentage of receiving PC increased from 3.6% in 1999 to 14.2% by the end of 2000 (adjusted OR (aOR)=4.07, 95% CI 2.70 to 6.13) and from 20.9% in 2010 to 41.0% in 2013 (aOR=1.40, 95% CI 1.33 to 1.47), vasopressor use decreased from 71.6% in 1999 to 35.5% in 2001 (aOR=0.90, 95% CI 0.82 to 0.98). Among PDD, PC use increased from 0.2% in 2009 to 4.9% in 2013 (aOR=2.05, 95% CI 1.60 to 2.63) and cardiopulmonary resuscitation use decreased from 17.6% in 2009 to 10.0% in 2013 (aOR=0.83, 95% CI 0.76 to 0.90). CONCLUSIONS Implementation of the PC policy in Taiwan was associated with improved PC utilisation among patients with cancer and dementia, which may reduce unnecessary medical care procedures.
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Affiliation(s)
- Lou-Ching Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London W1T 7NF, United Kingdom
| | - Chia-Chin Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Pokfulam, Hong Kong
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Abstract
PURPOSE OF REVIEW Care near the end of life is expensive and frequently not aligned with the expressed preferences of decedents, creating an opportunity to improve value, or increase quality while lowering cost. This review examines publications from 2017 and 2018 on interventions and policies associated with high-value end-of-life care. Innovations in video and web-based advance care planning are promising to improve preference-congruent care at low cost. RECENT FINDINGS The patterns of care within hospice and in particular increased investment in patient care in hospice are shown to improve value. A meta-analysis demonstrated the role of inpatient palliative care consultations in decreasing hospitalization costs, as did several studies on inpatient palliative care units. Internationally, a range of home-based palliative care programs, implemented at the population level, demonstrated cost savings and reduced intensive care near the end of life. Finally, public policies that funded medical and long-term care and address broader inequalities were demonstrated to decrease low-value care near the end of life. SUMMARY This review demonstrates the efficacy of a range of approaches to improve value of care at the end of life, both within the health system and across public policy sectors.
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Chiang JK, Chen JS, Kao YH. Comparison of medical outcomes and health care costs at the end of life between dialysis patients with and without cancer: a national population-based study. BMC Nephrol 2019; 20:265. [PMID: 31311518 PMCID: PMC6636130 DOI: 10.1186/s12882-019-1440-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/25/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Palliative care has improved the quality of end-of-life (EOL) care and lowered the health care cost of cancer, and these benefits should be extended to patients with other serious illnesses including end-stage kidney disease. We evaluated the quality of EOL care, survival probabilities, and health care costs for dialysis patients in their last month of life. METHODS We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information of patient medical records, health care costs, and insurance system exit dates (our proxy for death between 2006 and 2011). RESULTS Data of 1177 adult patients who died of chronic hemodialysis or peritoneal dialysis were investigated. The mean age of these patients was 69.7 ± 11.9 years, and 585 (49.7%) were women. Some patients with dialysis received cardiopulmonary resuscitation (66.9%), died in a hospital (65.0%), or were admitted to an intensive care unit (51.0%) in the last month of life. We further classified these patients into two groups, namely dialysis with cancer (DC) (n = 149) and dialysis without cancer (D) (n = 1028). Only 19 dialysis patients received palliative care, and the proportion of patients receiving palliative care was higher in the DC group than in the D group (11.4% vs. 0.2%). The mean health care costs per person during the final month of life was similar between the DC and D groups (USD 2755 ± 259 vs. USD 2827 ± 88). Multivariate logistic regression showed that the DC group had lower odds of receiving cardiopulmonary resuscitation (CPR) (OR: 0.39, CI = 0.26-0.56, p < 0.001) procedures, higher odds of longer hospital stays than the third quartile (> 25 days) (OR: 1.52, CI = 1.01-2.29, p = 0.0046), and higher odds of being hospitalized more than once (OR: 2.26, CI = 1.42-3.59, p = 0.001) than the D group in the last month of life after adjustments. CONCLUSIONS DC patients received hospice care more frequently, received CPR less frequently, and had similar health care costs. DC patients also had a higher risk of a hospital stay that lasted more than 25 days and more than one hospitalization compared with D patients in the final month of life.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2, Minsheng Road, Dalin, 622, Chiayi, Taiwan
| | - Jean-Shi Chen
- Department of Nephrology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), 670 Chung-Te Road, Tainan, 701, Taiwan
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), 670 Chung-Te Road, Tainan, 701, Taiwan.
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Taylor JS, Zhang N, Rajan SS, Chavez-MacGregor M, Zhao H, Niu J, Meyer LA, Ramondetta LM, Bodurka DC, Lairson DR, Giordano SH. How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients. Gynecol Oncol 2019; 152:452-458. [PMID: 30876488 PMCID: PMC7152986 DOI: 10.1016/j.ygyno.2018.10.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe disparities in patterns of hospice use and end-of-life costs among ovarian cancer patients. METHODS Using Texas Cancer Registry-Medicare data, ovarian cancer patients deceased 2005-2012 with >12 months of continuous Medicare coverage before death were included. Descriptive statistics and multivariable logistic regressions were used to evaluate patterns of hospice use. Cost and resource utilization was obtained from Medicare claims and analyzed using a non-parametric Mann-Whitney test. RESULTS 2331 patients were assessed: 1788 (77%) white, 359 (15%) Hispanic, 158 (7%) black and 26 (1%) other. 1756 (75%) enrolled in hospice prior to death but only 1580 (68%) died with hospice. 176 (10%) of 1756 patients unenrolled and died without hospice. 346 (20%) unenrolled from hospice multiple times. From 2008 to 2012, patients were less likely to unenroll from hospice prior to death. Black patients were more likely to unenroll from hospice prior to death (OR 2.07 [1.15-3.73]; p = 0.02) compared to white patients. The median amount paid by Medicare during the last six months of life was $38,530 for those in hospice compared to $49,942 if never enrolled in hospice (p < 0.0001) and was higher for black and Hispanic patients compared to white patients. 30% hospice unenrolled patients and 40% multiply enrolled hospice patients received at least one life extending or invasive care procedure following unenrollment from hospice. CONCLUSION Recently, more patients remain enrolled in hospice, but black patients have a higher risk of unenrollment. Hospice enrollment was associated with lower costs as long as a patient did not unenroll from hospice.
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Affiliation(s)
- Jolyn S Taylor
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, United States of America
| | - Ning Zhang
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, United States of America
| | - Suja S Rajan
- The University of Texas School of Public Health, Department of Management, Policy Sciences & Community Health, United States of America
| | - Mariana Chavez-MacGregor
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, United States of America
| | - Hui Zhao
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, United States of America
| | - Jiangong Niu
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, United States of America
| | - Larissa A Meyer
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, United States of America
| | - Lois M Ramondetta
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, United States of America
| | - Diane C Bodurka
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, United States of America
| | - David R Lairson
- The University of Texas School of Public Health, Department of Management, Policy Sciences & Community Health, United States of America
| | - Sharon H Giordano
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, United States of America.
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