An Interventional Study for the Early Identification of Patients With Palliative Care Needs and the Promotion of Advance Care Planning and Advance Directives.
J Pain Symptom Manage
; 59(5): 974-982.e3, 2020 05.
Article
in En
| MEDLINE
| ID: mdl-31759033
ABSTRACT
CONTEXT Programs identifying patients needing palliative care and promoting advance care planning (ACP) are rare in Asia. OBJECTIVES:
This interventional cohort study aimed to identify hospitalized patients with palliative care needs using a validated palliative care screening tool (PCST), examine the ability of the PCST to predict mortality, and explore effects of a pragmatic ACP program targeted by PCST on the utilization of life-sustaining treatment during the last three months of life.METHODS:
In this prospective study, we used PCST to evaluate patients' palliative care needs between 2015 and 2016 and followed patients for three months. ACP with advance directives (ADs) was systematically offered to all patients with PCST score ≥4.RESULTS:
Of 47,153 hospitalized patients, 10.4% had PCST score ≥4. During follow-up, 2121 individuals died within three months of palliative care screening 1225 (25.0%) with PCST score ≥4 and 896 (2.1%) with PCST score <4. After controlling for covariates, PCST score ≥4 was significantly associated with a higher mortality within three months of screening (adjusted odds ratio [AOR] 6.86; 95% CI 6.16-7.63). Moreover, ACP consultation (AOR 0.78; 95% CI 0.66-0.92) and AD completion (AOR 0.49; 95% CI 0.36-0.65) were associated with a lower likelihood of receiving life-sustaining treatments during the last three months of life.CONCLUSION:
We demonstrated the feasibility of implementing a comprehensive palliative care program to identify patients with palliative care needs and promote ACP and AD in Eastern Asia. ACP consultation and AD completion were associated with reduced utilization of life-sustaining treatments during the last three months of life.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Terminal Care
/
Advance Care Planning
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Guideline
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Ethics
Limits:
Humans
Language:
En
Journal:
J Pain Symptom Manage
Journal subject:
NEUROLOGIA
/
PSICOFISIOLOGIA
/
TERAPEUTICA
Year:
2020
Document type:
Article
Affiliation country:
Taiwan