Lu Ching-Yi, Shen Wen-Chi, Kao Chen-Yi, Wang Hung-Ming, Tang Shu-Chuan, Chin Tsu-Ling, Chi Chuan-Chuan, Yang Jin-Mei, Chang Chih-Wen, Lai Ying-Fen, Yeh Ya-Chi, Hung Yu-Shin, Chou Wen-Chi
From the Department of Nursing (C-YL, S-CT, T-LC, C-CC, J-MY, C-WC, Y-FL, Y-CY), Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou (W-CS, C-YK, H-MW, Y-SH, W-CC), and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan (W-CC).
Medicine (Baltimore). 2016 Mar;95(10):e2981. doi: 10.1097/MD.0000000000002981.
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.
自2005年起在台湾大力推广的缓和医疗咨询服务(PCCS)旨在为急性护理病房中的晚期绝症患者提供由合格跨学科专家组成的全面临终关怀。本研究旨在评估PCCS对晚期癌症患者的影响。
2006年至2014年间,共有10594名来自台湾某单一医疗中心并被转介至PCCS的晚期癌症患者被纳入研究。对晚期癌症患者及其家属的疾病知晓率、不进行心肺复苏(DNR)医嘱签署率、对缓和医疗的拒绝和接受情况进行了回顾性分析。
在PCCS开展初期,2006年至2014年间患者及其家属的疾病知晓率分别从25.4%升至37.9%(P = 0.007)和从61.2%升至84.7%(P = 0.001)。2006年至2014年间PCCS转介后患者的疾病知晓率从47.1%升至64.5%(P = 0.016)。PCCS转介后家属对诊断和预后的知晓率达到稳定平台期,不同年份队列中从94.1%至97.8%(P = 0.34)。PCCS开展初期(2006年)的DNR医嘱签署率为15.5%,该签署率逐年上升,最终在2014年达到42.0%(P = 0.004)。PCCS后的DNR同意率也从2006年的44.0%提高到2014年的80.0%(P = 0.005)。PCCS拒绝率逐渐下降,在2014年降至1.6%(P = 0.005)。在推广PCCS后的9年期间,PCCS利用率提高了5倍。
在PCCS推广项目中,2006年至2014年间在台湾观察到PCCS利用率呈上升趋势,患者及其家属对诊断和预后的知晓度提高,对DNR的同意更多,更多患者在PCCS结束时病情稳定出院,晚期癌症患者对临终缓和医疗的拒绝率下降。