An Interventional Study for the Early Identification of Patients With Palliative Care Needs and the Promotion of Advance Care Planning and Advance Directives

Yung-Feng Yen; Ya-Ling Lee; Hsiao-Yun Hu; Yun-Ju Lai; Wen-Jung Sun; Ming-Chung Ko; Chu-Chieh Chen; J Randall Curtis; Sheng-Jean Huang; Dachen Chu

doi:10.1016/j.jpainsymman.2019.10.006

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. 2020 May;59(5):974-982.e3. doi: 10.1016/j.jpainsymman.2019.10.006. Epub 2019 Nov 21.

Authors

Yung-Feng Yen¹, Ya-Ling Lee², Hsiao-Yun Hu³, Yun-Ju Lai⁴, Wen-Jung Sun⁵, Ming-Chung Ko⁶, Chu-Chieh Chen⁷, J Randall Curtis⁸, Sheng-Jean Huang⁹, Dachen Chu¹⁰

Affiliations

¹ Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
² Department of Dentistry, Taipei City Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
³ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
⁴ School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan; Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan.
⁵ Center of Research and Development in Community Based Palliative Care, Taipei City Hospital, Taipei, Taiwan; Holistic Social Preventive and Mental Health Center, Taipei City Hospital, Taipei, Taiwan; Community Medicine Department & Family Medicine Division, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan.
⁶ Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Department of Urology, Taipei City Hospital, Taipei, Taiwan.
⁷ Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
⁸ Division of Pulmonary, Critical Care, and Sleep Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.
⁹ Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan; Department of Surgery, Medical College, National Taiwan University Hospital, Taipei, Taiwan.
¹⁰ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan. Electronic address: DAD57@tpech.gov.tw.

PMID: 31759033
DOI: 10.1016/j.jpainsymman.2019.10.006

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.

Keywords: Palliative care programs; advance care planning; advance directives; life-sustaining treatments; prospective studies.

MeSH terms

Advance Care Planning*
Advance Directives
Cohort Studies
Humans
Palliative Care
Prospective Studies
Terminal Care*