Impact of Combined Hospice Care on Terminal Cancer Patients

Abstract

Background: Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system. Patients and Methods: From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed. Results: A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% ( p < 0.0001), and awareness of disease prognosis from 46.05% to 57.69% ( p ¼ 0.0006). Combined hospice care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%). Conclusions: Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.

Relationship between palliative care consultation service and end-of-life outcomes

“…The chaplain who is a PCCS team member routinely provided emotional and spiritual support to patients and family members even when hospice wards were not available [13]. The major symptoms presented by terminal patients were pain (58 %), dyspnea (52 %), constipation (45 %), and fatigue (23 %) [9]. Chang et al conducted a retrospective study recruiting 313 terminal cancer patients from March 2005 to January 2006 and showed that the patients who received home care had better performance status, less shortness of breath, less limb swelling, less flatulence, and less constipation.…”

“…Chou et al conducted a retrospective study in terminal cancer patients receiving PCCS in Taiwan and identified that lower disease awareness was associated with older age (age>75 years versus age=18-65 years), referral from nononcology departments, and primary cancer localization (lung, colon-rectum, or urological versus liver) [7]. Loke et al identified that there was a significant improvement in the rate of DNR signed orders from 41.5 to 71.5 % (p<0.0001), in the awareness of disease prognosis from 46.1 to 57.7 % (p=0.0006), and in hospice utilization by terminal cancer patients after receiving combined hospice care [9]. Tsai et al demonstrated that most common sites of primary cancer in terminal cancer patients admitted to the palliative care unit were lung (23.4 %), liver (15.6 %), and stomach (13 %).…”

“…Yang et al used a comprehensive approach for hospice shared care in Taiwan and indicated that patients aged <60 years experience more physical, psychosocial, and spiritual suffering [8]. Loke et al reported experiences with PCCS in Taiwan and indicated that there was a significant improvement in the number of patients signing rate of do-not-resuscitate (DNR) orders, awareness of disease prognosis, and hospice utilization by terminal cancer patients [9]. Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient palliative care in the last month of life revealed that palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit [10].…”

A Systematic Review of Palliative Care Intervention Outcomes and Outcome Measures in Low-Resource Countries

“…11 Recent studies also demonstrate that meeting national care standards reduces hospital admissions and deaths for patients and that combining hospice care with acute care for terminal cancer patients can improve quality of life. 12,13 Studies in high-resource areas also demonstrate that early palliative care for oncology patients can decrease the use of anticancer treatments in the last 30 days of life. 14,15 Such studies are not routinely conducted in low-resource countries, 16 which are 84 countries classified by the World Bank as low and lower middle-income countries.…”

“Do Not Resuscitate” Orders Among Deceased Patients Who Received Acute Neurological Care

“… 3 However, the use of DNR orders may be complicated by ethnical, cultural, economic, and family values. Therefore, combining clinical and hospice care in the acute ward can enhance the acceptance of DNR, 4 as well as natural death. 5…”