Insufficient pain control for patients with cancer and dementia during terminal cancer stages.

PURPOSE: To estimate differences in pain control between patients with cancer and with or without dementia during terminal cancer stages 3 months or 1 month before cancer death. PATIENTS AND METHODS: We conducted frequency matching cohort for age, sex, and year of death for both groups at a 1:4 ratio. The prescription prevalence, total cumulative dose, and average daily dose of opioids during the terminal cancer stages 3 months and 1 month before cancer death were estimated. RESULTS: Patients with cancer and dementia were prescribed lower amounts of opioids 3 months before death (57.5% vs. 73.9%, respectively; adjusted odds ratio [OR] 0.46; 95% confidence interval [CI] 0.44-0.49) and 1 month before death (54.4% vs. 70.3%, respectively; adjusted OR 0.50; 95% CI 0.47-0.53). The total cumulative dose of opioids (mg) was lower in patients with cancer and dementia 3 and 1 month(s) before death (3 months: 1,578 mg vs. 2,666 mg, respectively; ß=-1,125.9, P<0.001; 1 month: 921 mg vs. 1,533 mg, respectively; ß=-622.1, P<0.001). The average daily opioid dose (mg/day), patients with cancer and dementia received a lower dose 3 months before death (31 mg vs. 48 mg; ß=-22.6, P<0.001) and 1 month before death (38 mg vs. 60 mg; ß=-17.1, P<0.001). CONCLUSION: The prevalence of opioid prescription was significantly lower in patients with both cancer and dementia during their terminal cancer stages 3 months and 1 month before death.

Palliative inter-professional learning via cased based tele-videoconference: Experience from the hospice development stage in Taiwan and China.

ABSTRACT: Palliative care in rural areas can be difficult to assess and, often is of lower quality compared to more densely populated regions. A program of multicenter palliative care discussion forum via tele-videoconference may be a promising tool for exchanging valuable experience and constructing a comprehensive hospice care system in Taiwan and China.The multicenter palliative care discussion forum began 1997 and 2010 in Taiwan and China, respectively. In every forum, 1 to 2 cases were presented by multiple field specialists, and multi-dimensional problems were discussed. All of these case reports and reference materials from the forums were analyzed.The conference discussed 199 and 143 cases in Taiwan and China, including 172 and 143 cancer patients. The most common mentioned symptom was pain (66.3% in Taiwan, 96.95% in China). As time went on, the rate of discussion in pain management issues decreased, but the social and psycho-spiritual issues increased in Taiwan. After some major legal and social changes, the discussion of ethical issues increased rapidly. In China, the trends and ranking in discussion of nonpain management issues stabilized and showed most frequently in psycho-spiritual issues, followed by social, ethical and legal issues.Sharing palliative experience via tele-videoconferences is an effective tool to improve the quality of care, and also saves a significant amount of time and expense. Experts in different professions from different hospitals should discuss any palliative problems, share their valuable experience, and ponder a comprehensive hospice care.

Increased risk of perforated appendicitis in patients with schizophrenia and dementia: A population-based case-control study.

Previous studies have suggested that patients with psychotic or mental disorders are relatively pain insensitive, resulting in difficulties in the diagnosis of acute intra-abdominal diseases requiring emergency surgeries. We aimed to evaluate whether central nervous system (CNS) or mental disorders are associated with perforated appendicitis in patients with acute appendicitis.We conducted a population-based case-control study using Taiwan's National Health Insurance Research database. Patients aged >18 years who had been hospitalized with a diagnosis of acute appendicitis between 2000 and 2013 were identified. After 1:1 matching for age and sex, 2792 patients with perforated appendicitis (case group) and 2792 patients with nonperforated appendicitis (control group) were included. CNS disorders, mental disorders, pain control medication, and several comorbidities were analyzed for the odds of appendiceal perforation with 95% confidence interval (CI) using the multivariable logistic regression model.Schizophrenia and dementia were associated with a high risk of appendiceal rupture in patients with acute appendicitis, with an adjusted odds ratio of 2.01 for dementia (95% CI: 1.19-3.39, P = .009) and 4.8 for schizophrenia (95% CI: 1.62-14.19, P = .005). Other factors, such as other CNS disorders, comorbidities, and pain control medication, were not associated with the risk of perforated appendicitis.Dementia and schizophrenia are associated with perforated appendicitis in patients with acute appendicitis. This might be owing to altered pain perception, difficult symptom expression, and delayed hospitalization. Further studies are still needed to determine the underlying mechanism and confirm the causality.

The Hospice Information System and its association with the congruence between the preferred and actual place of death.

OBJECTIVE: A Hospice Information System (HIS) developed in eastern Taiwan in 2012 aimed to improve the quality of hospice care through an integrated system that provided telemetry-based vital sign records, online 24/7 consultations, online video interviews, and online health educations. The purpose of this study was to explore the congruence between the preferred and actual place of death (POD) among patients who received HIS services. MATERIALS AND METHODS: A retrospective study was performed from January 2012 to August 2016. Data from patients enrolled in the HIS who died during this period were included. Data on basic characteristics and the actual and preferred POD were obtained from the HIS database. The primary outcome was the congruence between the preferred and actual POD. Secondary outcomes were comparisons between patients who did and did not achieve their preferred POD. Further comparisons between patients who did and did not achieve home death were also performed. RESULTS: In total, we enrolled 481 patients who received HIS services and died. Of them, 444 (92.3%) died at their preferred POD. Patients who preferred an inpatient hospice as their POD had higher achievement rate than those who wanted a home death. High-intensity HIS utilization was associated with a higher likelihood of home death than low-intensity HIS utilization. Patients living in areas distant from the medical center had lower achievement of home death than those living in local areas. CONCLUSIONS: This study suggested that patients enrolled in the HIS had high congruence between the actual and preferred POD.