Changes in the Use of Intensive and Supportive Procedures for Patients With Stroke in Taiwan in the Last Month of Life Between 2000 and 2010

Wang, Pei Yi; Hung, Yen Ni; Smith, Robert

doi:10.1016/j.jpainsymman.2017.11.024

Cited by 9 publications

(9 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2015, the Taiwanese legislature passed the Patient Right to Autonomy Act, which is the first law in Asia aimed at protecting a patient's right to autonomy, including exercising the right to refuse medical treatments through ADs [28]. After the passing of the Hospice Palliative Care Act, Taiwan experienced an increase in supportive care use in different intensive care units for stroke patients and a decline in the use of intensive procedures [29]. In addition, population-based studies have found that the implementation of palliative care policies in Taiwan was associated with improved palliative care utilization in connection with cancer, dementia, chronic obstructive pulmonary disease, and stroke [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

“…After the passing of the Hospice Palliative Care Act, Taiwan experienced an increase in supportive care use in different intensive care units for stroke patients and a decline in the use of intensive procedures [29]. In addition, population-based studies have found that the implementation of palliative care policies in Taiwan was associated with improved palliative care utilization in connection with cancer, dementia, chronic obstructive pulmonary disease, and stroke [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Advance care planning preferences in Chinese nursing home residents: results from two cross-sectional studies in Hong Kong and Taiwan

2021

BMC Palliat Care

Self Cite

View full text Add to dashboard Cite

Background The proportion of hospital deaths has declined in the past few decades, while the proportions of nursing home deaths have increased. This trend of increasing deaths in long-term care facilities underlines the importance of improving end-of-life care provisions in these settings to meet individual preferences and needs. Under these circumstances, a comprehensive understanding of end-of-life care preferences in local nursing home residents can help healthcare professionals and policymakers develop strategies to increase the advance directive completion rate and quality of care. This study aimed to explore and compare advance directive and end-of-life care preferences of nursing home residents in Hong Kong and Taiwan. Methods A structured questionnaire was developed by the research team to investigate advance directive and end-of-life care preferences in older Chinese nursing home residents. Nursing home residents with frail or pre-frail status and over the age of 64 were invited to participate in the study, and information on demographics, functional status, advance directive experiences, and end-of-life care expectations was collected through questionnaire interviews. Results A total of 325 eligible participants from 32 facilities completed the survey, including 238 older residents in Hong Kong and 87 in Taiwan. A significantly lower proportion of the Hong Kong residents had completed an advance directive compared with the Taiwanese (3 vs. 13%, p = 0.001). Among participants who did not have an advance directive, 46% of the Taiwanese participants said they would consider completing one in the future, compared with 20% of the Hong Kong participants (p < 0.001). A total of 79% of the Hong Kong participants and 80% of the Taiwanese participants responded that prolonging life in the given hypothetical dying scenario was “not important” (p = 0.76). Only 14% of participants in Hong Kong and 18% of participants in Taiwan reported prior occurrence of end-of-life care discussions with family members or health professionals (p = 0.37). Conclusions This paper adds evidence in support of improving end-of-life communication and the advance directive completion rate in nursing homes in Hong Kong and Taiwan. Further research is necessary to explore cross-cultural differences in end-of-life preferences and its applications in predicting decision-making and the quality of end-of-life care.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Advance care planning preferences in Chinese nursing home residents: results from two cross-sectional studies in Hong Kong and Taiwan

2021

BMC Palliat Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…Each multivariate logistic regression model was adjusted for age, sex, insurance premium level, urbanization level of the hospital location, accreditation level of the hospital, ownership of the hospital, and Charlson Comorbidity Index, and these confounders have been described as determinants of these invasive procedures in previous studies. 6,27,28 The results of multivariate analysis were stratified by disease type. Stratum 1 comprised the COPD decedents, and stratum 2 comprised the LC decedents.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Health Care Utilization Between Chronic Obstructive Pulmonary Disease and Lung Cancer Patients

Kuo

Chen

Lee

et al. 2019

Journal of Pain and Symptom Management

Self Cite

View full text Add to dashboard Cite

Context. At the end of life, chronic obstructive pulmonary disease (COPD) and lung cancer (LC) patients exhibit similar symptoms; however, a large-scale study comparing end-of-life health care utilization between these two groups has not been conducted in East Asia.Objectives. To explore and compare end-of-life resource use during the last six months before death between COPD and LC patients.Methods. Using data from the Taiwan National Health Insurance Research Database, we conducted a nationwide retrospective cohort study in COPD (n ¼ 8640) and LC (n ¼ 3377) patients who died between 1997 and 2013.Results. The COPD decedents were more likely to be admitted to intensive care units (57.59% vs 29.82%), to have longer intensive care unit stays (17.59 vs 9.93 days), and to undergo intensive procedures than the LC decedents during their last six months; they were less likely to receive inpatient (3.32% vs 18.24%) or home-based palliative care (0.84% vs 8.17%) and supportive procedures than the LC decedents during their last six months. The average total medical cost during the last six months was approximately 18.42% higher for the COPD decedents than for the LC decedents.Conclusion. Higher intensive health care resource use, including intensive procedure use, at the end of life suggests a focus on prolonging life in COPD patients; it also indicates an unmet demand for palliative care in these patients. Avoiding potentially inappropriate care and improving end-of-life care quality by providing palliative care to COPD patients are necessary.

show abstract

“…Furthermore, the Patient Right to Autonomy Act was passed by the Taiwanese legislature in 2015 and it was the first law in Asia to protect a patient’s right to autonomy including exercising the right to refuse medical treatments through ADs [ 47 ]. Several population-based studies revealed that the implementation of palliative care policies, namely the Patient Right to Autonomy Act in Taiwan was associated with improved palliative care utilization in regards to cancer and non-cancer diseases such as chronic obstructive pulmonary disease, dementia, and stroke [ 48 – 50 ]. This underscores the benefits of having ADs and therefore the importance of exploring the influential predictors of signing ADs in terminally ill patients.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of advance directive among terminally ill patients in Taiwan before enactment of Patient Right to Autonomy Act: a nationwide population-based study

2022

Self Cite

View full text Add to dashboard Cite

Background Signing advance directives (ADs) ensures that terminally ill patients receive end-of-life care, according to their wishes, thereby promoting human dignity and sparing them from unnecessary suffering. Despite the enactment of the Hospice Palliative Care Act in Taiwan in 2000, the completion rates of ADs have been found to be low among patients with chronic illness conditions. To date, limited existing research is available regarding the factors associated with AD completion in terminally ill patients in Taiwan. To explore signed AD characteristics, compare differences in signing ADs between patients with and without cancer, and examine the factors associated with signing ADs in terminally ill patients. Methods A nationwide study was conducted using data collected via a retrospective review of medical death records from 18 randomly selected hospitals in the northern, central, and southern parts of Taiwan. We collected 200 records, including both cancer and non-cancer-related deaths, from each hospital. Univariate and multivariate logistics regressions were conducted to examine factors associated with signing advance directives among all patients- with and without cancer. Results Among the 3004 reviewed medical records, 79% had signed ADs, with most (95%) being signed by patients’ caregivers. A higher education level (OR = 1.52, 95% CI = 1.10, 2.08, p = 0.010); cancer diagnosis (OR = 2.37, 95% CI = 1.79, 3.16, p < 0.001); having family members (OR = 5.62, 95% CI = 2.95, 10.69, p < 0.001), care homes (OR = 4.52, 95% CI = 1.97, 10.38, p < 0.001), friends, or maids (OR = 3.82, 95% CI = 1.76, 8.29, p = 0.001) as primary caregivers; and patients knowing about their poor prognosis (OR = 15.39, 95% CI = 5.66, 41.83, p < 0.001) were associated with a higher likelihood of signing ADs. Conclusions Patients with non-malignant chronic illnesses were less likely to have ADs signed by either patients or family caregivers than those with cancer, with the lowest likelihood observed in patients with cardiovascular diseases. Whenever possible, primary caregivers should be involved in discussing ADs with patients, and the importance of truth telling should be reinforced. Following these principles, each patient’s end-of-life care preferences can be respected, thereby promoting quality of care before the patient’s death.

show abstract

Changes in the Use of Intensive and Supportive Procedures for Patients With Stroke in Taiwan in the Last Month of Life Between 2000 and 2010

Cited by 9 publications

References 24 publications

Advance care planning preferences in Chinese nursing home residents: results from two cross-sectional studies in Hong Kong and Taiwan

Advance care planning preferences in Chinese nursing home residents: results from two cross-sectional studies in Hong Kong and Taiwan

End-of-Life Health Care Utilization Between Chronic Obstructive Pulmonary Disease and Lung Cancer Patients

Prevalence and predictors of advance directive among terminally ill patients in Taiwan before enactment of Patient Right to Autonomy Act: a nationwide population-based study

Contact Info

Product

Resources

About