Abstract
BackgroundsEarly integration of palliative care for terminally ill non-cancer patients improves quality of life. However, there are scanty data on Palliative Care Consultation Service (PCCS) among non-cancer patients.MethodsIn this 9-year observational study Data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill non-cancer patients with 9 categories of diagnoses who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in categories of diagnosis throughout study period, duration of PCCS, patient outcomes, DNR declaration, awareness of disease by patients and families before and after PCCS.ResultsIn total, 536 non-cancer patients received PCCS from 2011 to 2019 with an average age of 70.7 years. The average duration of PCCS was 18.4 days. The distributions of age, gender, patient outcomes, family’s awareness of disease before PCCS, and patient’s awareness of disease after PCCS were significantly different among the diagnoses. Organic brain disease and Chronic kidney disease (CKD) were the most prevalent diagnoses in patients receiving PCCS in 2019. For DNR declaration, the percentage of patients signing DNR before PCCS remained high throughout the study period (92.8% in 2019). Patient outcomes varied according to the disease diagnoses.ConclusionThis 9-year observational study showed that the trend of PCCS among non-cancer patients had changed over the duration of the study. An increasing number of terminally ill non-cancer patients received PCCS during late life, thereby increasing the awareness of disease for both patients and families, which would tend to better prepare terminally ill patients for end-of-life as they may consider DNR consent. Early integration of PCCS into ordinary care for terminally non-cancer patients is essential for better quality of life.
Highlights
The world is rapidly aging [1]
Study group identification We enrolled terminally ill non-cancer patients who were admitted to Taichung Veterans General Hospital (TCVGH) and referred to Palliative Care Consultation Service (PCCS) from Jan 2011 to Dec 2019
After analyzing patient outcomes in non-cancer patients, we found that patients with chronic kidney disease and organic brain disease had more chances to be referred to palliative care unit, while dementia patients were more referred to palliative home care
Summary
The world is rapidly aging [1]. Because of improvements in public health and medical interventions, life expectancy has increased worldwide in recent decades, and Palliative care has been demonstrated to relieve symptoms near end-of-life [5], to overcome psychologicalLin et al BMC Palliative Care (2021) 20:181 distress [6], and to improve quality of life for cancer patients and their family members [7, 8]. The importance of palliative care for non-cancer terminally ill patients has been brought to light in multiple studies [9,10,11]. Studies have shown that palliative care among non-cancer patients can reduce rates of emergency department visits, admissions to hospital, and admissions to the intensive care unit during end-of-life [12]. A previous study showed that early integration of palliative care for patients with diseases other than cancer can improve breathlessness [13], increase DoNot-Resuscitate (DNR) consent, and increase patients’ and families’ recognition of the diagnosis [14]. A previous study has shown that PCCS during hospitalization for cancer patients can improve patients’ and families’ awareness of disease diagnosis and prognosis, and increase consent to DNR [18]. Symptom control was better when receiving PCCS among cancer patients [19]
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