Support Care Cancer DOI 10.1007/s00520-015-2741-6
ORIGINAL ARTICLE
Relationship between palliative care consultation service and end-of-life outcomes Li-Fen Wu 1 & Chi-Ming Chu 2 & Yu-Guang Chen 3 & Ching-Liang Ho 3 & Hsueh-Hsing Pan 1,4
Received: 6 January 2015 / Accepted: 13 April 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract Purpose Palliative care consultation service (PCCS) is currently utilized to provide care to terminal patients in Taiwan. However, there is little research on the relationship between PCCS and end-of-life outcomes. This study aimed to elucidate the association between PCCS and end-of-life outcomes in terminal cancer patients. Methods Retrospective chart reviews of terminal cancer patients who consulted the PCCS of a medical center in Taiwan from January 2007 to December 2012 were performed. Data on 1369 patients were recorded, which included details of outcomes such as discharge from hospital, transfer to hospice ward, and death after PCCS termination. Other variables such as demographics, disease-related information, symptoms, and psychosocial needs were also evaluated. Logistic regression models were employed to estimate the adjusted odds ratios and related 95 % confidence intervals. Results The Eastern Cooperative Oncology Group performance status, timing of do-not-resuscitate (DNR) signature, dyspnea, and spiritual problems experienced by the families were important predictors for terminal cancer patients who
* Hsueh-Hsing Pan [email protected] 1
Department of Nursing, Tri-Service General Hospital, Taipei City, Taiwan
2
School of Public Health, National Defense Medical Center, Taipei City, Taiwan
3
Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
4
School of Nursing, National Defense Medical Center, Taipei City, Taiwan
were discharged from the hospital or had expired at the time of PCCS termination. Age, referral department, primary cancer diagnosis, timing of DNR signature, pain, dyspnea, and the family’s spiritual problems were the key predictors for patients who were transferred to the hospice ward or had expired. Conclusions This study confirms the outcomes of PCCS and highlights the important predictors for patients at PCCS termination. These factors can be targeted to improve and enhance the quality of PCCS rendered in the future. Keywords Terminal cancer patients . Palliative care consultation service . End of life . Outcomes
Introduction Hospice care, also known as palliative care, was first started in the UK over 30 years ago, and since then, it has expanded worldwide [1]. It focused on optimizing the quality of life of patients and their families who were facing problems associated with life-threatening illnesses through the prevention and relief of suffering by early identification and an impeccable assessment and treatment of pain and other physical, psychosocial, and spiritual problems [2]. More recent research has found that palliative care improved relationships, stabilized emotional attitudes toward death, increased the rate of preference for dying at home, as well as contributed to improvements in the quality of care and the quality of life and death of severely ill patients and their relatives [3–5]. In Taiwan, palliative care has been implemented to care for patients with terminal illnesses for nearly two decades. Because of the limited beds available in a hospice ward, our government advocated palliative care consultation service (PCCS) in our clinic to make palliative care available to more
Support Care Cancer
patients. PCCS is a hospital-based combined care approach that provides various options to medical team members involved in the care of terminal patients in acute wards [6]. The team, which is comprised of qualified physicians, nurse specialists, social workers, psychologists, and a chaplain, aims to achieve better quality of care by providing symptomatic treatment and providing holistic care for patients and their families at the end of the patient’s life [7]. Recent studies have begun to explore the effects or outcomes of PCCS in Taiwan. Yang et al. used a comprehensive approach for hospice shared care in Taiwan and indicated that patients aged
ORIGINAL ARTICLE
Relationship between palliative care consultation service and end-of-life outcomes Li-Fen Wu 1 & Chi-Ming Chu 2 & Yu-Guang Chen 3 & Ching-Liang Ho 3 & Hsueh-Hsing Pan 1,4
Received: 6 January 2015 / Accepted: 13 April 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract Purpose Palliative care consultation service (PCCS) is currently utilized to provide care to terminal patients in Taiwan. However, there is little research on the relationship between PCCS and end-of-life outcomes. This study aimed to elucidate the association between PCCS and end-of-life outcomes in terminal cancer patients. Methods Retrospective chart reviews of terminal cancer patients who consulted the PCCS of a medical center in Taiwan from January 2007 to December 2012 were performed. Data on 1369 patients were recorded, which included details of outcomes such as discharge from hospital, transfer to hospice ward, and death after PCCS termination. Other variables such as demographics, disease-related information, symptoms, and psychosocial needs were also evaluated. Logistic regression models were employed to estimate the adjusted odds ratios and related 95 % confidence intervals. Results The Eastern Cooperative Oncology Group performance status, timing of do-not-resuscitate (DNR) signature, dyspnea, and spiritual problems experienced by the families were important predictors for terminal cancer patients who
* Hsueh-Hsing Pan [email protected] 1
Department of Nursing, Tri-Service General Hospital, Taipei City, Taiwan
2
School of Public Health, National Defense Medical Center, Taipei City, Taiwan
3
Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
4
School of Nursing, National Defense Medical Center, Taipei City, Taiwan
were discharged from the hospital or had expired at the time of PCCS termination. Age, referral department, primary cancer diagnosis, timing of DNR signature, pain, dyspnea, and the family’s spiritual problems were the key predictors for patients who were transferred to the hospice ward or had expired. Conclusions This study confirms the outcomes of PCCS and highlights the important predictors for patients at PCCS termination. These factors can be targeted to improve and enhance the quality of PCCS rendered in the future. Keywords Terminal cancer patients . Palliative care consultation service . End of life . Outcomes
Introduction Hospice care, also known as palliative care, was first started in the UK over 30 years ago, and since then, it has expanded worldwide [1]. It focused on optimizing the quality of life of patients and their families who were facing problems associated with life-threatening illnesses through the prevention and relief of suffering by early identification and an impeccable assessment and treatment of pain and other physical, psychosocial, and spiritual problems [2]. More recent research has found that palliative care improved relationships, stabilized emotional attitudes toward death, increased the rate of preference for dying at home, as well as contributed to improvements in the quality of care and the quality of life and death of severely ill patients and their relatives [3–5]. In Taiwan, palliative care has been implemented to care for patients with terminal illnesses for nearly two decades. Because of the limited beds available in a hospice ward, our government advocated palliative care consultation service (PCCS) in our clinic to make palliative care available to more
Support Care Cancer
patients. PCCS is a hospital-based combined care approach that provides various options to medical team members involved in the care of terminal patients in acute wards [6]. The team, which is comprised of qualified physicians, nurse specialists, social workers, psychologists, and a chaplain, aims to achieve better quality of care by providing symptomatic treatment and providing holistic care for patients and their families at the end of the patient’s life [7]. Recent studies have begun to explore the effects or outcomes of PCCS in Taiwan. Yang et al. used a comprehensive approach for hospice shared care in Taiwan and indicated that patients aged
