Background
Physicians’ recognition of end of life (EOL) has key influences on patients’ “good death”.
Aim
We aimed to study physicians’ attitude towards EOL, and to analyze the relationship between physicians’ assessment and patients’ actual survival and the trigger effect on patient’s access to palliative consultation and palliative care.
Design
This is a multi-center retrospective cohort study in seven community hospitals in Taiwan.
Methods
Inpatients admitted between March 1, 2016 and December 31, 2020, scored ≧ 4 points using Taiwan version-Palliative Care Screening Tool (TW-PCST), and expired before December 31, 2020 were enrolled. Physicians answered three questions regarding these inpatients: “surprised of mortality within 6-12 months”, “EOL”, and “in need of palliative care”. We followed up patients’ actual survival and access to palliative consultation and services.
Results
We enrolled 10,304 cases. There was high correlation among the three questions. The median survival of patients with “not surprised of death within 6-12 months”, “EOL”, and “needing palliative care” were 68, 60, and 58 days, respectively. Those with opposite responses were 206 days, 166 days, and 186 days, respectively. Patients’ main diagnosis, TW-PCST score, physicians’ palliative care qualifications and reward measures were all associated with physicians’ recognition of EOL. Physicians’ assessment, physicians’ training, disease characteristics and TW-PSCT scores were all associated with palliative consultation and palliative care.
Conclusions
Physicians are still over optimistic in recognizing inpatients’ survival and palliative care needs. EOL talks can be initiated when the TW-PCST score is high. Universal palliative care training can be integrated into medical education.