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

Shih, Tzu Chien; Chang, Hsiao Ting; Lin, Ming Hwai; Chen, Chun Ku; Chen, Tzeng Ji; Hwang, Shinn Jang

doi:10.1186/s12904-018-0271-y

Cited by 23 publications

(20 citation statements)

References 23 publications

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“…It has been suggested that palliative care patterns should differ for cancer patients versus non-cancer patients because of distinct disease progression (e.g., steady progression and clear terminal phase for cancer versus gradual decline punctuated by episodes of acute deterioration and more sudden death for respiratory or heart failure [14]. Although palliative care is beneficial for non-cancer patients and their families, the use of palliative care services among noncancer patients is much lower than for cancer patients, and palliative care referral tends to be later [15][16][17][18]. According to the Clinical Practice Research Datalink in England, in 2009, only 234 (7%) of 3122 patients with heart failure were given palliative care by family physicians or referred to special palliative care services, compared to 3669 (48%) of 7608 cancer patients [15].…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

2020

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Background: Palliative care is a patient-centred, integrated approach for improving quality of life for both patients facing life-threatening illnesses and for their families. Although there has been increased interest in palliative care for non-cancer patients, the palliative care competency of nurses who care for non-cancer patients has rarely been investigated. This study described the palliative care knowledge, attitude, confidence, and educational needs in nurses who care for patients with congestive heart failure, stroke, end-stage renal disease, and end-stage liver disease; explored the relationships between those variables; and identified factors affecting nurses' palliative care confidence. Methods: A cross-sectional, descriptive, correlational design was employed; data collection was conducted at a tertiary hospital in Seoul, Korea. Nurses who were working in general wards and intensive care units (N = 102) completed valid and reliable self-administered questionnaires. Descriptive statistics, frequencies, independent t-tests, one-way ANOVA, Pearson's correlations, and multiple regression were conducted to analyse the data. Results: Nurses' palliative care knowledge level was low (9.73 ± 2.10; range = 0-20) and their attitude toward palliative care was moderate (87.97 ± 6.93, range: 30-120). Knowledge was significantly correlated with attitude (r = .29, p = .003). Nurses were highly confident in pain and symptom management but demonstrated high educational needs for managing human and material resources to provide palliative care. Previous training in hospice, palliative, and EOL care was a significant and modifiable factor that affected nurses' confidence (std. β = 0.25, p = .010). Conclusions: To facilitate high-quality palliative care for non-cancer patients and families, nursing education programs should be developed to address nurses' knowledge level, confidence level, and educational needs. This study provides relevant information that can be utilised to develop palliative care educational programs for nurses who care for non-cancer patients.

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Section: Introductionmentioning

confidence: 99%

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

2020

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“…1,2 However, 83.7% to 85.7% of our participants issued a DNR order before death, close to the worldwide predeath prevalence of DNR orders for patients with cancer: 86% reported in the United States, 9 92% in Canada, 10 76% in Korea, 46 74.7% 11 to 80.0% 12 in China, and 94.9% in Taiwan. 13 Discrepancies between DNR orders issued at hospital admission, 8,9,17 for outpatients, 28 or at enrollment in our study and at death reflect lost opportunities to identify a DNR preference due to physicians' insufficiencies in addressing patients' CPR preferences and inadequate patient engagement, as reported by El-Jawahri et al, 8 highlighting the need for effective interventions to identify the CPR preferences of patients with cancer and to facilitate issuance of DNR orders. Although our ACP intervention did not strongly facilitate the overall prevalence of issuing a DNR order before death, as reported, 34,35 it effectively promoted DNR order issuance by helping patients with advanced cancer to develop accurate PA (Table 2), especially among those first reporting accurate PA 31 to 90 days before death (Table 3).…”

Section: Discussionmentioning

confidence: 61%

“…The median time proximities to death since our participants issued a DNR were longer than those reported in the United States (1 day) 9 and China (1 day) 11,12 but comparable to those reported in Canada (6 days) 10 and Taiwan (7 days). 13 Correspondingly, 20.7% to 26.2% and 35.9% to 38.1% of our participants ordered a DNR on the day of death and within 3 days of death, respectively, comparable to or better than reported prevalences: ,26% in Canada, 10 28.1% in Korea, 14 and 41.1% in China 12 on the day of death and 64.7% in Korea 14 and 81.9% in China 12 within 3 days of death. Our findings and those in the literature regarding the time proximity between issuing a DNR order and death signal that physician-patient EoL care communication is delayed and suboptimal.…”

Section: Discussionmentioning

confidence: 99%

“…8 DNR orders are typically issued close to death. 1,[9][10][11][12][13][14][15][16] No DNR order or a late one can signal suboptimal physicianpatient EoL care communication, leading to more lifesustaining treatments (LSTs) 10,14,17,18 and poor EoL care quality. [17][18][19] Timely, adequate EoL care discussions cultivate patients' accurate prognostic awareness (PA), 20 allowing them to realistically appraise their illness/life expectancy and come to terms with their forthcoming death, thereby increasing the likelihood of issuing a DNR order.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating if an Advance Care Planning Intervention Promotes Do-Not-Resuscitate Orders by Facilitating Accurate Prognostic Awareness

Wen

Chen

Chou

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: Issuing do-not-resuscitate (DNR) orders has seldom been an outcome in randomized clinical trials of advance care planning (ACP) interventions. The aim of this study was to examine whether an ACP intervention facilitating accurate prognostic awareness (PA) for patients with advanced cancer was associated with earlier use of DNR orders. Patients and Methods: Participants (n=460) were randomly assigned 1:1 to the experimental and control arms, with 392 deceased participants constituting the final sample of this secondary analysis study. Participants in the intervention and control arms had each received an intervention tailored to their readiness for ACP/prognostic information and symptom-management education, respectively. Effectiveness in promoting a DNR order by facilitating accurate PA was determined by intention-to-treat analysis using multivariate logistic regression with hierarchical linear modeling. Results: At enrollment in the ACP intervention and before death, 9 (4.6%) and 8 (4.1%) participants and 168 (85.7%) and 164 (83.7%) participants in the experimental and control arms, respectively, had issued a DNR order, without significant between-arm differences. However, participants in the experimental arm with accurate PA were significantly more likely than participants in the control arm without accurate PA to have issued a DNR order before death (adjusted odds ratio, 2.264; 95% CI, 1.036–4.951; P=.041). Specifically, participants in the experimental arm who first reported accurate PA 31 to 90 days before death were significantly more likely than their counterparts in the control arm who reported accurate PA to have issued a DNR order in the next wave of assessment (adjusted odds ratio, 13.365; 95% CI, 1.989–89.786; P=.008). Both arms issued DNR orders close to death (median, 5–6 days before death). Conclusions: Our ACP intervention did not promote the overall presence of a DNR order. However, our intervention facilitated the issuance of NDR orders before death among patients with accurate PA, especially those who reported accurate PA 31 to 90 days before death, but it did not facilitate the issuance of DNR orders earlier than their counterparts in the control arm.ClinicalTrial.gov Identification: NCT01912846

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“…that the hospice palliative care enrollment rates of noncancer patients remained substantially lower than those of cancer patients 14 .…”

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confidence: 87%

Better continuity of care improves the quality of end-of-life care among elderly patients with end-stage renal disease

Chen

Chen²,

Kuo

2020

Sci Rep

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Continuity of care (COC) has been emphasized in research on terminal cancer patients to increase the quality of end-of-life care; however, limited research has been conducted on end-stage renal disease patients. We applied a retrospective cohort design on 29,095 elderly patients with end-stage renal disease who died between 2005 and 2013. These patients were identified from the National Health Insurance Research Database of Taiwan. The provider Continuity of Care Index (COCI) and site COCI were calculated on the basis of outpatient visits during the 6–12 months before death. We discovered that increases in the provider COCI were significantly associated with reductions in health expenditures after adjusting for confounders, especially in inpatient and emergency departments, where the treatment intensity is high. Higher provider and site COC were also associated with lower utilization of acute care and invasive treatments in the last month before death. Provider COC had a greater effect on end-of-life care expenditures than site COC did, which indicated significant care coordination gaps within the same facility. Our findings support the recommendation of prioritizing the continuity of end-of-life care, especially provider continuity, for patients with end-stage renal disease.

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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

Cited by 23 publications

References 23 publications

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

Evaluating if an Advance Care Planning Intervention Promotes Do-Not-Resuscitate Orders by Facilitating Accurate Prognostic Awareness

Better continuity of care improves the quality of end-of-life care among elderly patients with end-stage renal disease

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