A comprehensive approach in hospice shared care in Taiwan: Nonelderly patients have more physical, psychosocial and spiritual suffering

Enhancing the Quality of Hospice Shared Care for End-Stage Malignant Tumor Patients: A Structure-process-outcome Three-Dimensional Quality Evaluation Model

Background: The progression of end-stage malignant tumors in patients is irreversible, making high-quality hospice care especially critical. Objective: To evaluate the effectiveness of the hospice shared care guided by the structure-process-outcome three-dimensional quality evaluation model compared to the hospice shared care in patients with end-stage malignant tumors. Design: This study is a single-center, open-label, randomized controlled trial, conducted in the Department of Radiation Oncology at the Second People's Hospital of Wuhu City. Methods: The control group adopted the standard hospice shared care, while the intervention group utilized the hospice shared care guided by the structure-process-outcome three-dimensional quality evaluation model. The quality of life, spiritual well-being, psychological distress, and satisfaction of patients were compared between the two groups. Results: After two and four weeks of intervention, there was a significant improvement in quality of life and spiritual health, along with a notable reduction in psychological distress (P < 0.05). Compared with the control group, patients in the intervention group exhibited significantly better quality of life and mental health status, along with lower psychological distress scores (P < 0.05). The satisfaction rate in the intervention group was significantly higher than that in the control group (97.80% vs 92.31%, P = 0.029). Conclusions: Guided by the three-dimensional quality evaluation model of structure-process-outcome, the hospice shared care can significantly improve the quality of life and spiritual health of patients with end-stage malignant tumors, alleviate psychological distress, and enhance patient satisfaction.

Associations among knowledge, attitudes, and practices toward palliative care consultation service in healthcare staffs: A cross-sectional study

Background

The palliative care consultation service (PCCS) of the National Health Insurance payments has been promoted in Taiwan since 2011, although few studies have been conducted on healthcare staffs’ knowledge, attitudes, and practices regarding PCCS in Taiwan; consequently, the main objective of this study was to explore any correlations regarding the above by cross-sectional design using convenience sampling.

Methods

A total of 210 healthcare staff members were enrolled from a regional hospital from June 1, 2018, to September 30, 2018. Questionnaire items on the Palliative Care Consultation Service Inventory (KAP-PCCSI) were used to measure healthcare staff’s knowledge, attitudes, and practices of PCCS. The collected data were analyzed by using descriptive statistics, independent samples t-test, Pearson’s correlation coefficient analysis, and multiple linear regression analysis.

Results

The results revealed that the mean scores for knowledge of and attitudes of KAP-PCCSI were 58.7 ± 8.9 (perfect score: 75) and 42.7 ± 4.7 (perfect score: 50) respectively, while the mean score for practices of KAP-PCCSI was 36.3 ± 8.1 (perfect score: 50); moreover, the healthcare staff’s knowledge and attitudes were positively correlated with their practices (p < 0.01). The results also showed that knowledge, attitudes, experience of having a family member(s) or friend(s) passing away, and being a medical personnel constituted the major predictors of practices (p < 0.001). These factors explained 43.2% of the overall variance for practices of KAP-PCCSI.

Conclusions

The findings can help healthcare staff understand factors influencing practices of KAP-PCCSI and can serve as a reference for the development of strategies for palliative care education and training while improving the care quality of patients undergoing such palliative care with terminal life considerations in the hospitals, thereby fulfilling the goal of achieving holistic care.

Symptom Burden and End-of-Life Palliative Treatments during the Last Two Weeks of Life in Patients with Advanced Musculoskeletal Sarcoma

Background: Musculoskeletal sarcomas (MSSs) are rare cancers and often aggressive tumors that originate from mesenchymal tissue. Patients with advanced MSS often report difficulties with symptom burden, which can reduce their health-related quality-of-life. Objective: The aim of this study was to describe the patterns of the physical symptoms of MSS patients in the palliative setting and to detail the palliative treatment used in the last two weeks of life. Design: Retrospective study using the electronic patient records from a single institution. Setting/Subjects: A retrospective study was carried out in a sample of 46 consecutive MSS patients with locally advanced/metastatic disease, who were hospitalized and died in our department. The median age of these patients was 56 years at death. Measurements: Symptom burden and medical intervention during the last two weeks of life were collected. Results: The most frequent physical symptoms were pain and dyspnea in 93% and 78% of patients, respectively, while only 17% of patients suffered from nausea. A total of 98% of patients required opioids, and most patients were treated with morphine through either subcutaneous or intravenous continuous injection. Nonsteroidal anti-inflammatory drugs and acetaminophen were administered to 79% of patients. Corticosteroids were administered for the relief of dyspnea to 83% of patients. Of the patients, 46% received palliative chemotherapy within the last two weeks of life, and the oral treatment was continued until a median of 5.6 days before death. In addition, 39% of patients received a sedative treatment during the last two weeks of life for uncontrolled refractory symptoms. Conclusions: The symptom burden experienced by advanced MSS patients is profound at the end of life for all palliative approaches. Therefore, palliative medicine is an important and even crucial component of the continuum of care, allowing for aggressive symptom management with a variety of medical interventions, including palliative sedation.

Spiritual Distress Within Inpatient Settings-A Scoping Review of Patients' and Families' Experiences

CONTEXT

Spiritual distress contributes to patients' and families' experiences of care.

OBJECTIVES

To map the literature on how seriously ill patients and their family members experience spiritual distress within inpatient settings.

METHODS

Our scoping review included four databases using search terms "existential" or "spiritual" combined with "angst," "anxiety," "distress," "stress," or "anguish." We included original research describing experiences of spiritual distress among adult patients or family members within inpatient settings and instrument validation studies. Each study was screened in duplicate for inclusion, and the data from included articles were extracted. Themes were identified, and data were synthesized.

RESULTS

Within the 37 articles meeting inclusion criteria, we identified six themes: conceptualizing spiritual distress (n = 2), diagnosis and prevalence (n = 7), assessment instrument development (n = 5), experiences (n = 12), associated variables (n = 12), and barriers and facilitators to clinical support (n = 5). The majority of studies focused on patients; two studies focused on family caregivers. The most common clinical settings were oncology (n = 19) and advanced disease (n = 19). Terminology to describe spiritual distress varied among studies. The prevalence of at least moderate spiritual distress in patients was 10%-63%. Spiritual distress was experienced in relation to self and others. Associated variables included demographic, physical, cognitive, and psychological factors. Barriers and facilitators were described.

CONCLUSION

Patients' and families' experiences of spiritual distress in the inpatient setting are multifaceted. Important gaps in the literature include a narrow spectrum of populations, limited consideration of family caregivers, and inconsistent terminology. Research addressing these gaps may improve conceptual clarity and help clinicians better identify spiritual distress.

Relationship between palliative care consultation service and end-of-life outcomes

PURPOSE

Palliative care consultation service (PCCS) is currently utilized to provide care to terminal patients in Taiwan. However, there is little research on the relationship between PCCS and end-of-life outcomes. This study aimed to elucidate the association between PCCS and end-of-life outcomes in terminal cancer patients.

METHODS

Retrospective chart reviews of terminal cancer patients who consulted the PCCS of a medical center in Taiwan from January 2007 to December 2012 were performed. Data on 1369 patients were recorded, which included details of outcomes such as discharge from hospital, transfer to hospice ward, and death after PCCS termination. Other variables such as demographics, disease-related information, symptoms, and psychosocial needs were also evaluated. Logistic regression models were employed to estimate the adjusted odds ratios and related 95% confidence intervals.

RESULTS

The Eastern Cooperative Oncology Group performance status, timing of do-not-resuscitate (DNR) signature, constipation, and spiritual problems experienced by the patients were important predictors for terminal cancer patients who were discharged from the hospital or had expired at the time of PCCS termination. Age, gender, primary cancer diagnosis, timing of DNR signature, constipation, and other physical symptoms were the key predictors for patients who were transferred to the hospice ward or had expired.

CONCLUSIONS

This study confirms the outcomes of PCCS and highlights the important predictors for patients at PCCS termination. These factors can be targeted to improve and enhance the quality of PCCS rendered in the future.