公衛所 Faculty Seminar
時間：110年3月8日(一) 12:10 – 13:10
(Time: 12:10 PM, 8^th March)
地點：醫學二館221室
(Location: Rm221, Medical BuildingII)
An Interventional Program for the Early Identification of Patients with Palliative Care Needs and the Promotion of Advance Care Planning and Advance Directives in Taipei, Taiwan
Abstract
Context. Programs identifying patients needing palliative care and promoting advance care planning (ACP) are rare in Asia.
Objectives. This interventional cohort study aimed to identify hospitalized patients with palliative care needs using a validated Palliative Care Screening Tool (PCST), examine the ability of the PCST to predict mortality, and explore effects of a pragmatic ACP program targeted by PCST on the utilisation of life-sustaining treatment during the last three months of life.
Methods: In this prospective study, we used PCST to evaluate patients’ palliative care needs between 2015 and 2016 and followed patients for 3 months. ACP with advance directives (AD) were systematically offered to all patients with PCST score ≥4.
Results: Of 47,153 hospitalized patients, 10.4% had PCST score ≥4. During follow-up, 2,121 individuals died within three months of palliative care screening: 1,225 (25.0%) with PCST score ≥4 and 896 (2.1%) with PCST score <4. After controlling for co-variates, PCST score ≥4 was significantly associated with a higher mortality within 3 months of screening (adjusted odds ratio [AOR], 6.86; 95% confident interval [CI], 6.16-7.63). Moreover, ACP consultation (AOR=0.78, 95%CI: (0.66-0.92) and AD completion (AOR=0.49, 95%CI: 0.36-0.65) were associated with a lower likelihood of receiving life-sustaining treatments during the last 3 months of life.
Conclusions: We demonstrated the feasibility of implementing a comprehensive palliative care program to identify patients with palliative care needs and promote ACP and AD in East Asia. ACP consultation and AD completion were associated with reduced utilization of life-sustaining treatments during the last 3 months of life.
Speaker:
顏永豐(台北市立聯合醫院陽明院區感染科主任)