Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
Int J Environ Res Public Health. 2021 Dec 22;19(1):85. doi: 10.3390/ijerph19010085.
Hospice and early palliative care are generally considered as an alternative and supportive care to offer symptoms relief and optimize the quality of life among end-stage renal disease (ESRD) patients, but hospice care remains underutilized. This study aimed to examine patient and health system characteristics and develop a patient assessment scale to evaluate ESRD patients for hospice care after the implementation of non-cancer hospice care reimbursement policy in 2009 in Taiwan.
We conducted a retrospective cohort study using nationwide population-based datasets. Adult long-term dialysis patients between 2009 and 2012 were included. Multivariable logistic regression and the Firth penalized likelihood estimation were used to estimate the likelihood of receiving hospice care. A receiver operating characteristic curve (ROC) analysis and C-statistic were calculated to determine the optimal models for a patient assessment of hospice use.
Patients who were older, comorbid with anemia (odds ratio [OR] 3.53, 95% CI 1.43-8.70) or sepsis (OR 1.62, 95% CI 1.08-2.44), with longer dialysis durations, more hospitalizations (OR 4.68, 95% CI 2.56-8.55), or primary provider care with hospice (OR 5.15, 95% CI 2.80-9.45) were more likely to receive hospice care. The total score of the patient assessment scale of hospice care was 0-28 with a cut-off value of 19 based on the results of the receiver operating characteristic curve.
Given the "Patient Right to Autonomy Act" implemented in Taiwan in 2019 to promote the concept of a "good quality of death", this patient assessment scale may help health professionals target ESRD patients for hospice care and engage in shared decision making and the advance care planning process.
临终关怀和早期姑息治疗通常被认为是一种替代和支持性治疗，可以缓解终末期肾病（ESRD）患者的症状，提高生活质量，但临终关怀的利用率仍然较低。本研究旨在探讨患者和卫生系统特征，并开发一种患者评估量表，以便在 2009 年台湾实施非癌症临终关怀报销政策后，对 ESRD 患者进行临终关怀评估。
我们使用全国基于人群的数据集进行了回顾性队列研究。纳入 2009 年至 2012 年期间的成年长期透析患者。采用多变量逻辑回归和 Firth 惩罚似然估计来估计接受临终关怀的可能性。计算受试者工作特征曲线（ROC）分析和 C 统计量，以确定用于评估临终关怀使用的最佳模型。
年龄较大、合并贫血（优势比 [OR] 3.53，95%可信区间 [CI] 1.43-8.70）或败血症（OR 1.62，95% CI 1.08-2.44）、透析时间较长、住院次数较多（OR 4.68，95% CI 2.56-8.55）或由提供临终关怀的初级保健提供者治疗（OR 5.15，95% CI 2.80-9.45）的患者更有可能接受临终关怀。基于 ROC 分析结果，临终关怀患者评估量表的总分为 0-28，以 19 为截断值。
鉴于台湾于 2019 年实施的“患者自主权利法”，以推广“高质量死亡”的概念，该患者评估量表可能有助于卫生专业人员为 ESRD 患者提供临终关怀，并参与共同决策和预先护理计划过程。
