We prospectively identified prognostic factors and developed a prognostic scale in 356 Taiwanese terminal cancer patients (training set). Demographic data, severity of symptoms/signs, and survival were statistically analyzed to create the scale, which was tested in another 184 patients (testing set). In the training set, liver and lung metastases, functional performance status, weight loss, edema, cognitive impairment, tiredness, and ascites were independently associated with shorter survival (multivariate analysis). The scale ranged from 0.0 (no altered variables) to 8.5 (maximal alteration for all variables). When scores were < 3.5, 2-week survival was predicted with 0.72 and 0.61 accuracy for the training and testing sets, respectively. With scores < 6.0, 1-week survival was predicted with 0.72 and 0.66 accuracy, respectively. This scale, which includes lung and liver metastases and severity of symptoms/signs, may help in identifying the stage of dying and its corresponding symptoms/signs and also in improving survival prediction in terminal cancer patients.

The study investigated the puzzling factors and solutions of family-related barriers to truthfulness with patients with terminal cancer through a nationwide survey conducted in Taiwan. Two-hundred twenty-nine valid questionnaires were retrieved (91.6%) from 250 palliative care workers at 15 Taiwan hospices. Most of the respondents were nursing staff (72.5%), and only 38 respondents were physicians (16.6%). Canonical correlation analysis was used to examine the association between the puzzling factors and solutions, which revealed that the value of the first variate was 0.39 (P < .05). Results showed that the puzzling factors of barriers and canonical loadings were families do not know how to tell the truth (.85), families believe it is unnecessary to tell aged patients the truth (.71), and patients can be happier without knowing the truth (.70). The valid solutions correlated significantly with the above puzzling factors and were ranked in the following order: communicate with and encourage families to accept patients' prognoses (.83), discuss the sickness gently with patients and determine what patients know (.76), and tell the families about the possible emotional reactions in patients and how to provide support (.72). In conclusion, for solving family-related barriers to truthfulness in cases of terminal cancer, the results suggest that health professionals communicate with families first and discuss the possible emotional reactions from patients, give patients enough time to reflect on their sicknesses and discuss further what patients have been told, and then disclose information based on patients' expectations and support them.

Many medical professionals are still confused when facing the reduction of food or fluid intake in terminal cancer patients. The aim of this study was to assess the frequency and causes of the inability of eating or drinking in terminal cancer patients and to investigate the use of artificial nutrition and hydration (ANH); the frequency, type, and the extent to which staff found ANH to be ethically justified. Three hundred forty-four consecutive patients with terminal cancer admitted to a palliative care unit in Taiwan were recruited. A structured data collection form was used daily to evaluate clinical conditions, which were analyzed at the time of admission, 1 week after admission and 48 h before death. One hundred thirty-three (38.7%) of the 344 patients were unable to take water or food orally on admission; the leading cause was GI tract disturbances (58.6%). This impaired ability to eat or drink had become worse 1 week after admission (39.1%, P<0.01) and again 48 h before death (60.1%, P<0.001). The total rate of ANH use declined significantly, from 57.0% to 46.9% 1 week after admission ( P<0.001), but rose again to the same level as at admission in the 48 h before death (53.1%, P=0.169). Parenteral hydratation could be reduced significantly 1 week after admission ( P<0.05), but no reduction was possible in the 48 h before death; nor was it possible to reduce the nutrition administered. Multiple Cox regression analysis shows that the administration of ANH, either at admission or 2 days before death, did not have any significant influence on the patients' survival (HR: 0.88, 95% CI: 0.58-1.07; HR: 1.03, 95% CI: 0.76-1.38). In conclusion, sensitive care and continuous communication will probably lessen the use of ANH in terminal cancer patients. We have found it easier to reduce artificial hydratation than artificial nutrition, which corresponds to local cultural practice. Whether or not ANH was used did not influence survival in this study. Thus, the goals of care for terminal cancer patients should be refocused on the promotion of quality of life and preparation for death, rather than in simply making every effort to improve the status of hydratation and nutrition.

This is the first report of milk-alkali syndrome not caused iatrogenically, but by recreational usage of oyster shell preparations of betelnuts.

Patient-related barriers and their solution in the planning of discharge to palliative home care were investigated through a nationwide survey conducted in Taiwan. Of 250 questionnaires sent to palliative care workers at 15 hospices in Taiwan, 229 valid questionnaires (91.6%) were retrieved. Most of the respondents were nursing staff (72.5%) while only 38 were physicians (16.6%). Canonical correlation analysis was used to examine the association between the barriers and solutions, and revealed that the value of the first variate was 0.49 ( P<0.05). The barriers and canonical loadings were: unable to manage emergent medical conditions (0.83), the quality of care in the hospital is better (0.74), and insufficient number of caregivers (0.72). The effective solutions that correlated significantly with the above factors were ranked as: to reassure the patient about the possibility of smooth readmission (0.84), to arrange palliative home care programs (0.68), and to educate family members on taking care of the patient at home (0.64). In conclusion, to solve patient-related barriers in the planning of the discharge of patients with terminal cancer, the results suggest that (1). health professionals involved in the care of patients with terminal cancer should have adequate knowledge of palliative care, particularly communication skills, (2). an effective referral system among general or oncology and palliative care units should be established, (3). inpatient care facilities and home-care programs should be provided, and (4). patients and families should be educated as to what may happen and how to manage these conditions at home and should be assured of the availability of medical help.