The online version of this article (doi:10.1186/s12904-015-0036-9) contains supplementary material, which is available to authorized users.
The authors declare no conflict of interest.
YHK contributed to the conception, design, and drafting of the manuscript. JKC analyzed and interpreted the data. Both revised and approved the final version.
Quality of near end-of-life (EOL) care is typically evaluated using six accepted quality indicators (QIs). Research has yet to evaluate the quality of EOL care for liver cancer patients in Taiwan. We evaluated the effect of hospice care on the quality of EOL care for patients with advanced liver cancer.
Using claims data obtained from the Taiwan National Health Insurance Research Database, we analyzed the QIs of EOL care for patients who died between 2000 and 2011. Logistic regression was performed to identify predictors for QIs of EOL care.
A total of 3092 adult patients died of liver cancer during the study period. The patients were divided into those who received hospice care for a period longer than 1 month (long-H group), shorter than 1 month (short-H group), and not at all (non-H group). There was no significant difference in survival probability among the three groups (p = 0.212). Compared with the non-H group, the long- and short-H groups exhibited a significantly lower risk of being admitted to an intensive care unit (ICU) (odds ratios [ORs] = 0.25 and 0.26, respectively, p < 0.001) and requiring cardiopulmonary resuscitation (CPR) during the final month of life (ORs = 0.21 and 0.09, respectively, p < 0.001). Compared with the non-H group, the short-H group had a higher risk of more than one emergency room (ER) visit, and more than one hospital admission (OR = 1.97, p = 0.003; and OR = 1.56, p = 0.001, respectively), but the long-H group did not differed significantly from the non-H group on these measures.
Patients with liver cancer who received hospice care were less likely to be admitted to ICUs or require CPR compared with those who received no hospice care. A longer duration of hospice care was associated with reduced risks of more than one ER visit and more than one hospital admission. We conclude that EOL cancer care in Taiwan might be improved by implementing policies encouraging early hospice referral programs.
Additional file 1: Factors associated with quality indicators of end-of-life care among patients with liver cancer. Figures are odds ratios (confidence intervals) and associated p values. Abbreviations: Non-H group, patients who did not receive hospice care; Long-H group, patients who received hospice care for longer than 1 month; Short-H group, patients who received hospice care for a period shorter than 1 month; ICU, intensive care unit; CPR, cardiopulmonary resuscitation; ER, emergency room; HBV, hepatitis B virus; HCV, hepatitis C virus; SBP, spontaneous bacterial peritonitis; CKD, chronic kidney disease; LES, low socioeconomic status; MES, moderate socioeconomic status; HES, high socioeconomic status; PPV, positive predictive value; NPV, negative predictive value; AUC, area under the curve; HL, Hosmer–Lemeshow. (DOCX 18 kb)12904_2015_36_MOESM1_ESM.docx
GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed July 6, 2014.
Ministry of Health and Welfare. Available at http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2747. Accessed July 5, 2014.
Barbera L, Paszat L, Chartier C. Indicators of poor quality end-of-life cancer care in Ontario. J Palliat Care. 2006;22:12–7. PubMed
National Health Insurance Research Database. Available at http://nhird.nhri.org.tw/date_01.html. Accessed July 4, 2014.
Lin CC, Lai MS, Syu CY, Chang SC, Tseng FY. Accuracy of diabetes diagnosis in health insurance claims data in Taiwan. J Formos Med Assoc. 2005;104:157–63. PubMed
Department of Statistics, Ministry of Health and Welfare. http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=5012 Accessed June 12, 2015.
Chambaere K, Rietjens JAC, Cohen J, Pardon K, Deschepper R, Pasman HRW, et al. Is educational attainment related to end-of-life decision-making? A large post-mortem survey in Belgium. BMC Public Health. 2013;13:1055.
Chan CL, Chow AY. Death, dying and bereavement: the Hong Kong Chinese experience. Hong Kong: Hong Kong University Press; 2006.
The debate in hospice care. J Oncol Pract 2008 4: 153–7.
Ngo-Metzger Q, August KJ, Srinivasan M, Liao S, Meyskens Jr FL. End-of-Life care: guidelines for patient-centered communication. Am Fam Physician. 2008;77:167–74. PubMed
Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Malcolm H, et al. A systematic review of physicians' survival predictions in terminally ill cancer patients. BMJ. 2003;327:195–8.
- Effect of hospice care on quality indicators of end-of-life care among patients with liver cancer: a national longitudinal population-based study in Taiwan 2000–2011
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II