Department of Family Medicine, Taoyuan General Hospital, No. 1492, Zhongshan Rd., Taoyuan Dist, Taoyuan City, 330, Taiwan, Republic of China.
Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 11217, Taiwan, Republic of China.
BMC Palliat Care. 2018 Jan 24;17(1):18. doi: 10.1186/s12904-018-0271-y.
In 2009, the Taiwanese national health insurance system substantially expanded hospice coverage for terminal cancer patients to include patients with end-stage brain, dementia, heart, lung, liver, and kidney diseases. This study aimed to evaluate differences in do-not-resuscitate (DNR) status and hospice care utilization between terminal cancer patients and advanced non-cancer patients after the policy change.
Data were obtained from the Death and Hospice Palliative Care Database of Taipei Veterans General Hospital in Taiwan. The differences between cancer and non-cancer patients who died in this hospital between 2010 and 2015 were analyzed in terms of patient characteristics, rates of DNR orders, hospice care utilization, number of living days after DNR order, duration of survival (DOS) after hospice care enrollment, and the rate of late referral to hospice care.
Data for 8459 patients who died of cancer and major non-cancer terminal diseases were included. DNR order rate, hospice care utilization rate, and DOS were significantly higher for cancer patients than for non-cancer patients (p < 0.001, p < 0.001, and p < 0.001, respectively). The number of living days after DNR order and the late referral rate were significantly higher for non-cancer decedents than for cancer decedents (p < 0.001 and p < 0.001, respectively). From 2010 to 2015, there were significantly increasing trends in the hospice utilization rate, number of living days after DNR order, and rate of late referral for the cancer group (p < 0.001, p = 0.001, and p < 0.001, respectively). For the non-cancer group, there were significantly increasing trends in the rate of DNR order, hospice utilization rate, and number of living days after DNR order (p < 0.001, p < 0.001, and p = 0.029, respectively).
Further guidelines should be developed to help clinicians to promptly refer terminal cancer and non-cancer patients to hospice care. Considering the lower hospice utilization rate and the growing need for hospice care among terminal non-cancer patients, policymakers should consider how to improve the relevant levels of professional care to enhance the accessibility and availability of hospice care in Taiwan.
2009 年，台湾全民健康保险制度大幅扩大了终末期癌症患者的安宁疗护覆盖范围，将患有终末期脑、痴呆、心脏、肺、肝和肾病的患者也纳入其中。本研究旨在评估该政策改变后，癌症终末期患者与晚期非癌症患者之间在不施行心肺复苏术（DNR）意愿和安宁疗护使用方面的差异。
资料来源于台湾台北荣民总医院死亡与安宁缓和医疗资料库。分析了 2010 年至 2015 年期间在该院死亡的癌症患者和主要非癌症终末期患者在患者特征、DNR 医嘱率、安宁疗护使用率、DNR 医嘱后生存天数、安宁疗护入院后生存时间（DOS）以及晚期转介安宁疗护率方面的差异。
共纳入 8459 例死于癌症和主要非癌症终末期疾病的患者。与非癌症患者相比，癌症患者的 DNR 医嘱率、安宁疗护使用率和 DOS 均显著更高（p<0.001、p<0.001 和 p<0.001）。DNR 医嘱后生存天数和晚期转介率则显著更高（p<0.001 和 p<0.001）。2010 年至 2015 年期间，癌症组的安宁疗护使用率、DNR 医嘱后生存天数和晚期转介率呈显著上升趋势（p<0.001、p=0.001 和 p<0.001）。而非癌症组的 DNR 医嘱率、安宁疗护使用率和 DNR 医嘱后生存天数也呈显著上升趋势（p<0.001、p<0.001 和 p=0.029）。
应制定进一步的指南，帮助临床医生及时将癌症和非癌症终末期患者转介至安宁疗护。考虑到非癌症终末期患者的安宁疗护使用率较低且对安宁疗护的需求不断增加，决策者应考虑如何提高相关专业护理水平，以提高台湾安宁疗护的可及性和可获得性。
