Predictors and Assessment of Hospice Use for End-Stage Renal Disease Patients in Taiwan.

Hung-Cheng Chen,Chien-Yi Wu,Hui-Ya Hsieh,Hui-Min Hsieh,Jiun-Shiuan He,Shang-Jyh Hwang

doi:10.3390/ijerph19010085

Abstract

Objectives: Hospice and early palliative care are generally considered as an alternative and supportive care to offer symptoms relief and optimize the quality of life among end-stage renal disease (ESRD) patients, but hospice care remains underutilized. This study aimed to examine patient and health system characteristics and develop a patient assessment scale to evaluate ESRD patients for hospice care after the implementation of non-cancer hospice care reimbursement policy in 2009 in Taiwan. Method: We conducted a retrospective cohort study using nationwide population-based datasets. Adult long-term dialysis patients between 2009 and 2012 were included. Multivariable logistic regression and the Firth penalized likelihood estimation were used to estimate the likelihood of receiving hospice care. A receiver operating characteristic curve (ROC) analysis and C-statistic were calculated to determine the optimal models for a patient assessment of hospice use. Results: Patients who were older, comorbid with anemia (odds ratio [OR] 3.53, 95% CI 1.43–8.70) or sepsis (OR 1.62, 95% CI 1.08–2.44), with longer dialysis durations, more hospitalizations (OR 4.68, 95% CI 2.56–8.55), or primary provider care with hospice (OR 5.15, 95% CI 2.80–9.45) were more likely to receive hospice care. The total score of the patient assessment scale of hospice care was 0–28 with a cut-off value of 19 based on the results of the receiver operating characteristic curve. Conclusion: Given the “Patient Right to Autonomy Act” implemented in Taiwan in 2019 to promote the concept of a “good quality of death”, this patient assessment scale may help health professionals target ESRD patients for hospice care and engage in shared decision making and the advance care planning process.

Highlights

End-stage renal disease (ESRD) is a major cause of morbidity and mortality worldwide due to aging populations and the increasing prevalence of chronic kidney disease (CKD) [1].The number of patients with end-stage renal disease (ESRD) receiving renal replacement therapy (RRT) is projected to increase from 2618 million in 2010 to 5439 million worldwide by 2030 [1]
Regarding patient demographic and clinical characteristics, consistent with previous studies [14,25], this current study found that older dialysis patients were more likely to receive hospice care, especially those older than 75 years
The current study found that dialysis patients with specific dialysis-related complications were more likely to withdraw from dialysis and receive hospice care

Summary

Introduction

End-stage renal disease (ESRD) is a major cause of morbidity and mortality worldwide due to aging populations and the increasing prevalence of chronic kidney disease (CKD) [1]. The number of patients with ESRD receiving renal replacement therapy (RRT) is projected to increase from 2618 million in 2010 to 5439 million worldwide by 2030 [1]. In Taiwan, the prevalence of CKD is high, and ESRD incidence and prevalence are the highest in the world, based on United States Renal Data System international comparisons.

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