In 2009, the Taiwanese national health insurance system substantially expanded hospice coverage for terminal cancer patients to include patients with end-stage brain, dementia, heart, lung, liver, and kidney diseases. This study aimed to evaluate differences in do-not-resuscitate (DNR) status and hospice care utilization between terminal cancer patients and advanced non-cancer patients after the policy change.
Data were obtained from the Death and Hospice Palliative Care Database of Taipei Veterans General Hospital in Taiwan. The differences between cancer and non-cancer patients who died in this hospital between 2010 and 2015 were analyzed in terms of patient characteristics, rates of DNR orders, hospice care utilization, number of living days after DNR order, duration of survival (DOS) after hospice care enrollment, and the rate of late referral to hospice care.
Data for 8459 patients who died of cancer and major non-cancer terminal diseases were included. DNR order rate, hospice care utilization rate, and DOS were significantly higher for cancer patients than for non-cancer patients (p < 0.001, p < 0.001, and p < 0.001, respectively). The number of living days after DNR order and the late referral rate were significantly higher for non-cancer decedents than for cancer decedents (p < 0.001 and p < 0.001, respectively). From 2010 to 2015, there were significantly increasing trends in the hospice utilization rate, number of living days after DNR order, and rate of late referral for the cancer group (p < 0.001, p = 0.001, and p < 0.001, respectively). For the non-cancer group, there were significantly increasing trends in the rate of DNR order, hospice utilization rate, and number of living days after DNR order (p < 0.001, p < 0.001, and p = 0.029, respectively).
Further guidelines should be developed to help clinicians to promptly refer terminal cancer and non-cancer patients to hospice care. Considering the lower hospice utilization rate and the growing need for hospice care among terminal non-cancer patients, policymakers should consider how to improve the relevant levels of professional care to enhance the accessibility and availability of hospice care in Taiwan.
Stiel S, Matthies DM, Seuss D, Walsh D, Lindena G, Ostgathe C. Symptoms and problem clusters in cancer and non-cancer patients in specialized palliative care-is there a difference? J Pain Symptom Manag. 2014;48(1):26–35. CrossRef
Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manag. 2006;31(1):58–69. CrossRef
WHO Definition of Palliative Care. http://who.int/cancer/palliative/definition/en. Accessed 20 Jul 2017.
The National Council for Palliative Care. National Survey of Patient Activity Data for Specialist Palliative Care Services. In: MDS Full Report for the year 2011–2012. 2011–2012.
National Hospice and Palliative Care Organization. HHPCO facts and figures: hospice care in America; 2012. https://www.nhpco.org/hospice-statistics-research-press-room/facts-hospice-and-palliative-care.
Tang ST, Chen ML, Huang EW, Koong SL, Lin GL, Hsiao SC. Hospice utilization in Taiwan by cancer patients who died between 2000 and 2004. J Pain Symptom Manag. 2007;33(4):446–53. CrossRef
Cheung WY, Schaefer K, May CW, Glynn RJ, Curtis LH, Stevenson LW, Setoguchi S. Enrollment and events of hospice patients with heart failure vs. cancer. J Pain Symptom Manag. 2013;45(3):552–60. CrossRef
Shih TC, Chang HT, Lin MH, Chen CK, Chen TJ, Hwang SJ. Trends of Do-Not-Resuscitate Orders, Hospice Care Utilization, and Late Referral to Hospice Care among Cancer Decedents in a Tertiary Hospital in Taiwan between 2008 and 2014: A Hospital-Based Observational Study. Journal of palliative medicine 2017;20(8):838-844.
Christakis NA, Iwashyna TJ. Impact of individual and market factors on the timing of initiation of hospice terminal care. Med Care. 2000;38(5):528–41.
Stiel S, Heckel M, Seifert A, Frauendorf T, Hanke RM, Ostgathe C. Comparison of terminally ill cancer- vs. non-cancer patients in specialized palliative home care in Germany - a single service analysis. BMC palliative care. 2015;14:34.
Palliative Care and Pain Management at the End of Life. http://www.netce.com/coursecontent.php?courseid=1264. Accessed 20 Jul 2017.
Cohen J, Beernaert K, Van den Block L, Morin L, Hunt K, Miccinesi G, Cardenas-Turanzas M, Onwuteaka-Philipsen B, MacLeod R, Ruiz-Ramos M, et al. Differences in place of death between lung cancer and COPD patients: a 14-country study using death certificate data. NPJ primary care respiratory medicine. 2017;27(1):14. CrossRefPubMedPubMedCentral
Lin YH: The influence from palliative care education on the knowledge and attitude of medical students: a medical school survey from 2007 to 2011. http://cetd.tmu.edu.tw/etdservice/view_metadata?etdun=U0007-0807201315564700&from=DEPT&deptid=D0007007001. Accessed 25 Nov 2017.
eHospice: Hospice and palliative care in Taiwan. www . ehospice.com/ArticleView/tabid/10686/ArticleId/15164/ language/en-GB/Default.aspx. Accessed Nov 25, 2017.
- Differences in do-not-resuscitate orders, hospice care utilization, and late referral to hospice care between cancer and non-cancer decedents in a tertiary Hospital in Taiwan between 2010 and 2015: a hospital-based observational study
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
e.Med Kampagnen-Visual, Mail Icon II