Impact of Palliative Care Consultation Service on Terminally Ill Cancer Patients

Abstract

The palliative care consultation service (PCCS) that has been enthusiastically promoted in Taiwan since 2005 was designed to provide comprehensive end-of-life care for terminally ill patients with qualified interdisciplinary specialists in acute care ward setting. This study aims to evaluate the impact of PCCS on terminally ill cancer patients.A total of 10,594 terminal cancer patients who were referred to PCCS from a single medical center in Taiwan between 2006 and 2014 were enrolled. The percentages of patients’ and their families’ disease awareness, do-not-resuscitate (DNR) designation, refusal and acceptance of palliative care among terminally ill cancer patients were analyzed retrospectively.At the beginning of PCCS, the percentages of disease awareness among patients and their family were increased from 25.4% to 37.9% (P = 0.007) and from 61.2% to 84.7% between 2006 and 2014 (P = 0.001), respectively. Patients’ disease awareness after PCCS referral between 2006 and 2014 was increased from 47.1% to 64.5% (P = 0.016). Family's awareness of diagnosis and prognosis after PCCS referral researched to a steady plateau, 94.1% to 97.8% in different year cohort (P = 0.34). The percentage of DNR designation rate at the beginning of PCCS (in 2006) was 15.5%, and the designation rate was increased annually and finally reached to 42.0% in 2014 (P = 0.004). The percentage of DNR consents after PCCS was also improved from 44.0% in 2006 up to 80.0% in 2014 (P = 0.005). PCCS refusal rate decreased gradually and dropped to 1.6% in 2014 (P = 0.005). The percentage of PCCS utilization was increased 5-fold during the 9-year period after the promotion of PCCSIn the program of PCCS promotion, an increasing trend of PCCS utilization, better patients’ and their families’ awareness of diagnosis and prognosis, more consent to DNR, more patients were discharged with stable condition at the end of PCCS and a decrease refusal rate of end-of-life palliative care among terminal cancer patients were observed in Taiwan between 2006 and 2014.

The Effect of Hospice Consultation on Aggressive Treatment of Lung Cancer

“…This futile aggressive ICU care of terminal cancer patients, including mechanical support and frequent laboratory tests, improves neither survival outcome nor quality of life [ 23 , 24 ]. HC focuses mostly on advance care planning, elicits the values and preferences about aggressive care, such as CPR or mechanical ventilation, of patients and family, and helps them to make clear decisions about futile aggressive care [ 17 ]. When the patients do not receive HC, they have a little opportunity to understand the consequences of futile aggressive treatment.…”

“…To achieve adequate and timely utilization of hospice resources, hospice consultation (HC) should be the primary step towards hospice referral. However, little is known about the effect of HC on the aggressive care at the EOL [ 17 , 18 ].…”

Establishment of a Palliative Care Consultation Service (PCCS) in an Acute Hospital Setting

“…In conclusion, palliative care aims at a better quality of life and control of symptoms for patients with life-limiting diseases. To implement a PCCS, you need to establish a multidisciplinary team [ 9 , 39 , 40 ]. with nurses trained in PC and physicians from different specialties, such as internal medicine, anesthesiology, neurology, oncology and physical therapy, as well as trained psychologists.…”

Impact of patient-centred and family-centred care meetings on intensive care and resource utilisation in patients with terminal illness: a single-centre retrospective observational study in Taiwan

“…The palliative care consultation service has been implemented in terminally ill patients for decades in hospitals in the USA. In Taiwan, the Ministry of Health and Welfare (MOHW) introduced palliative care regulations in 20009; the palliative care consultation was designed to provide comprehensive EOL care for terminally ill patients, with qualified interdisciplinary specialists in acute care ward settings 10. In addition, the National Health Insurance Administration (NHIA) of the MOHW provided a fixed reimbursement of hospice care for both inpatient and home care 11.…”

“…In addition, the National Health Insurance Administration (NHIA) of the MOHW provided a fixed reimbursement of hospice care for both inpatient and home care 11. However, limited hospice resource and the patients’ lack of awareness of their disease progression were major reasons for the slight increase in hospice utilisation from 11% in 2001 to 17% in 2006 10. After that, the NHIA incorporated palliative care family consultation into the medical insurance programme for terminally ill patients in December 2012 9.…”