ABSTRACT
Purpose@#In Korea, hospice palliative care (HPC) provision for cancer patients has increased recently.However, whether end of life (EoL) care practices have improved along with the developmentof HPC is unclear. We intended to investigate the changes in EoL care practices and theirassociation with HPC referral. @*Materials and Methods@#Retrospective medical record review of adult cancer patients who died at National CancerCenter Korea from 1 January 2009 to 31 December 2014 was performed. Changes of EoLpractices including chemotherapy within 2 weeks from death, death in intensive care unit(ICU), documentation of “do not resuscitate (DNR)” within 7 days from death and referral toHPC from 2009 to 2014 were analyzed as well as the association between referral to HPCand other practices. @*Results@#A total of 2,377 cases were included in the analysis. Between 2009 and 2014, referral toHPC increased and DNR documentation within 7 days from death decreased significantly.Cases for chemotherapy within 2 weeks from death and death in ICU didn’t change overthe study period. Patients referred to HPC were less likely to receive chemotherapy within2 weeks from death, die in ICU and document DNR within 7 days from death. @*Conclusion@#During the study period, EoL practices among cancer patients partly changed toward lessaggressive in our institution. HPC referral was associated with less aggressive cancer careat the EoL. Policies to promote EoL discussion are necessary to improve the EoL practicesof cancer patients.
ABSTRACT
BACKGROUND: Establishing and designating specialized hospice palliative care units (HPCUs) has been an important part of national policy to promote hospice palliative care in Korea in the recent decade. However, few studies have sought to identify patterns and barriers for utilizing HPCU over the period of national policy implementation. We aimed to investigate factors related with utilizing HPCU for terminal cancer patients after consultation with a palliative care team (PCT). METHODS: We reviewed medical records for 1,028 terminal cancer patients who were referred to the PCT of the National Cancer Center in 2010 and 2014. We compared the characteristics of the patients who decided to utilize HPCU and those who did not. We also analyzed factors influencing choices for a medical institution and reasons for not selecting an HPCU. RESULTS: The patients' mean age was 61.0 ± 12.2, with lung cancer patients (24.3%) comprising the largest percentage of these patients. The percentage of referred patients who utilized an HPCU was 53.9% in 2014, increasing from 44.6% in 2010. Older age and awareness of terminal illness were found to be positively associated with utilization of an HPCU. The most common reason for not selecting an HPCU was “refusing hospice facility” (34.9%), followed by “near death,”“poor accessibility to an HPCU,” and “caregiving problems.” CONCLUSION: Compared to 2010, HPCU utilization by terminal cancer patients increased in 2014. Improving awareness of terminal condition among patients and family members and earlier discussion of end-of-life care would be important to promote utilization of HPCU.
Subject(s)
Humans , Hospices , Korea , Lung Neoplasms , Medical Records , Palliative Care , Referral and ConsultationABSTRACT
PURPOSE: Hospice and palliative care services (HPC) are not commonly utilized in Korea; however, palliative care teams (PCTs) have been found to be effective at addressing the shortcomings in HPC. In this study, we attempted to outline unmet palliative care needs of terminal cancer patients and the potential benefits of PCTs as perceived by doctors in Korea. MATERIALS AND METHODS: We surveyed 474 doctors at 10 cancer-related academic conferences from June to November 2014 with a self-report questionnaire to assess their perceptions of end-of-life care needs and the expected effects of PCTs on caring for terminal cancer patients. Among those surveyed, 440 respondents who completed the entire questionnaire were analyzed. RESULTS: In all domains, fewer participants reported satisfaction with palliative care services than those reporting needs (p < 0.001). The surveyed participants also reported difficulties with a shortage of time for treatment, psychological burden, lack of knowledge regarding hospice care, lengths of stay, and palliative ward availability. Multivariate logistic regression analysis revealed that female doctors (odds ratio [OR], 2.672; 95% confidence interval [CI], 1.035 to 6.892), doctors who agreed that referring my patients to a HPC means I must give up on my patient (OR, 3.075; 95% CI, 1.324 to 7.127), and doctors who had no experience with HPC education (OR, 3.337; 95% CI, 1.600 to 7.125) were associated with higher expected effectiveness of PCT activities. CONCLUSION: The PCT activities were expected to fill the doctor’s perceived unmet HPC needs of terminal cancer patients and difficulties in communications.
Subject(s)
Female , Humans , Congresses as Topic , Education , Hospice Care , Hospices , Korea , Logistic Models , Palliative Care , Referral and Consultation , Surveys and QuestionnairesABSTRACT
PURPOSE: Many end-of-life care studies are based on the assumption that there is a shared definition of language concerning the stage of cancer. However, studies suggest that patients and their families often misperceive patients' cancer stages and prognoses. Discrimination between advanced cancer and terminal cancer is important because the treatment goals are different. In this study, we evaluated the understanding of the definition of advanced versus terminal cancer of the general population and determined associated socio-demographic factors. MATERIALS AND METHODS: A total of 2,000 persons from the general population were systematically recruited. We used a clinical vignette of a hypothetical advanced breast cancer patient, but whose cancer was not considered terminal. After presenting the brief history of the case, we asked respondents to choose the correct cancer stage from a choice of early, advanced, terminal stage, and don't know. Multinomial logistic regression analysis was performed to determine sociodemographic factors associated with the correct response, as defined in terms of medical context. RESULTS: Only 411 respondents (20.6%) chose "advanced," while most respondents (74.5%) chose "terminal stage" as the stage of the hypothetical patient, and a small proportion of respondents chose "early stage" (0.7%) or "don't know" (4.4%). Multinomial logistic regression analysis found no consistent or strong predictor. CONCLUSION: A large proportion of the general population could not differentiate advanced cancer from terminal cancer. Continuous effort is required in order to establish common and shared definitions of the different cancer stages and to increase understanding of cancer staging for the general population.