Evaluation of Inpatient Multidisciplinary Palliative Care Unit on Terminally Ill Cancer Patients from Providers' Perspectives: A Propensity Score Analysis

Abstract

Objective: The effectiveness of inpatient palliative care units, a complex intervention, is challenging to evaluate due to methodological and practical difficulties. We conducted a study to evaluate providers' perceived effectiveness of one such unit. Methods: A non-concurrent, prospective, controlled study using the Audit Scale for good death services as an indicator of process of care and the Good Death Scale as the outcome of provider assessment of quality of dying was conducted. Eighty of 212 terminally ill cancer patients were matched from a tertiary medical center in Taiwan. Patients in the unit served as the intervention group and patients in the oncology ward served as controls. Multiple logistic regression was applied to estimate the propensity of choosing the unit for each patient, and linear regression analysis was conducted to identify predictive factors for mean change scores of the Good Death Scale. Results: Male gender (P , 0.001, 95% confidence interval ¼ 0.73-2.43) was associated with better quality of dying while having hepatocellular carcinoma (P , 0.004, 95% confidence interval ¼ 22.22 to 20.44) was associated with worse quality. For those in the unit, higher total Audit Scale scores were positively related to the outcome of quality of dying. The unit (P , 0.001, 95% confidence interval ¼ 8.67-12.97) and higher Good Death Scale at admission (P , 0.001, 95% confidence interval ¼ 0.44-1.13) were predictors of Audit Scale scores. Conclusions: Admission to a palliative care unit was associated with higher provider assessments of quality of dying for terminally ill cancer patients. These units should be considered as options for hospitals looking for ways to improve the quality of dying for patients.

Cancer patient autonomy and quality of dying-a prospective nationwide survey in Taiwan

“…The reliability and validity of the GDS in Taiwanese palliative care units have been well discussed in detail , and the instruments have been used and their results published in many journals . Cronbach's α was used to assess the internal consistency of this good death measure in the present study and was found to be 0.71 for the five domains.…”

Nosocomial Infections in Dialysis Access

“…Main components are (1) hand hygiene and basic infection control practices during catheter accessing process (e.g., aseptic technique, masks, hub disinfection), (2) access care at home, (3) role of and risks associated with catheters, and (4) knowing signs and symptoms of infection and when to notify the physician. Despite mixed results in other studies, Cheng et al [10] described a 40% lower risk of hospitalization due to infection and a 51% mortality reduction in patients with chronic kidney disease who received a multidisciplinary education prior to dialysis onset. We conclude that patient education is a valuable tool in the prevention of CLABSIs.…”

Cuidados paliativos em pessoas com carcinoma hepatocelular: uma revisão integrativa

“…Tal atitude melhora a qualidade de vida e da morte, especialmente para os que estão em estado terminal, fornecendo um cuidado holístico tanto para a pessoa o como para sua família (Cheng et al, 2013). É importante mencionar que os cuidados paliativos quando realizados precocemente, melhoram a qualidade de vida, bem como do humor e maior aumenta a sobrevida do indivíduo com CHC (Miguet et al, 2019;Herneaz & Hashem, 2018;Sakaguchi et al, 2016;Cheng et al, 2013).…”