Impact of the COVID-19 pandemic on the use of advance care planning services within the veterans administration system in Taiwan.

ABSTRACT

BACKGROUND: The aim of this study is to investigate the effect of COVID-19 on the outpatient advance care planning (ACP) services provided by veterans hospitals in Taiwan. METHODS: This study adopted a retrospective data analysis. We investigated ACP services provided by 15 veterans hospitals in Taiwan from 2019 to June 2020. We also conducted a statistical analysis on the ACP services provided by the Taipei Veterans General Hospital. RESULTS: From 2019 to June 2020, 15 veterans hospitals in Taiwan provided ACP services to 2493 individuals. The outpatient ACP services declined significantly after January 2020, decreasing from a national average of 206.2 ± 29.2 declarants per month to 106.2 ± 30.8 declarants per month in the 6 months immediately following the COVID-19 pandemic outbreak (p < 0.001). From the official implementation of the ACP in January 2019 to the end of June 2020, a total of 1126 declarants accepted ACP services at the Taipei Veterans General Hospital. When the COVID-19 pandemic was prevalent, the declarants who received ACP services were younger (i.e., 60.1 ± 15.2 vs 65.5 ± 16.3 years; p < 0.001). After the variables had been adjusted, the changes in the characteristics of the declarants receiving ACP services when the COVID-19 pandemic was prevalent were as follows a significant increase in the percentage of hospital staff receiving ACP services (odds ratio [OR] 5.460, 95% confidence interval [CI] 2.378-12.536); An increase in the percentage of declarants who paid for the ACP services received at their own expense (OR 3.417, 95% CI 1.591-7.339); and an increase in the percentage of declarants who received the consultations with three or more people (OR 2.017, 95% CI 1.278-3.182). CONCLUSION: COVID-19 severely changed outpatient ACP services provided by hospitals. The results obtained by this study offer valuable insight regarding the provision of outpatient ACP services.