| Summary: | 碩士 === 輔仁大學 === 護理學系碩士班 === 107 === Background: The mortality rate from cancer has risen steadily, and it has been the top leading cause of death in Taiwan. Death is the last stage of life. Terminal patients who have received invasive medical treatment such as cardiopulmonary resuscitation will not be able to improve their quality of life. Therefore, since 2005, the hospice-shared care has been promoted in non-hospice oncology wards.
Objectives: To investigate the difference of terminal medical treatment and quality of life for terminal cancer patients who receive hospice-shared care or not and to compare the change of pre- and post- quality of life among terminal patients who have received hospice-shared care.
Methods: The first part of this study was from April to October 2016. A retrospective study design was used and 160 cases were enrolled. The second part is from October 2016 to June 2017. A longitudinal study was designed to analyze the life quality of 36 patients. Both parts were performed in a medical center in the north of Taiwan. The data were analyzed using chi-square-test, fisher exact test, Wilcoxon signed-rank test, Mann-Whitney U-test, and generalized estimating equation (GEE) with SPSS 18.0 software.
Results: From the effect of hospice-shared care on terminal medical care: (1) Of the 160 cancer patients, 55.6% received hospice-shared care within six months before death, and the average number of days to their death was 21.8. 43.8% of terminal patients died within seven days and only 5.6% lived for more than three months after they received the hospice-shared care. Compared with patients not receiving hospice-shared care, most of patients who received hospice-shared care were under the age of 65, worked before ill, and were diagnosed with solid tumor. (2) Similarly, compared with patients not receiving hospice-shared care, within 22 days before they died, most of patients who received hospice-shared care had significantly higher rate signing DNR (100% vs 78.9%), and significantly lower rate to receive chemotherapy (10.1% vs 39.4%), surgery(3.4% vs 14.1%), endotracheal intubation (2.2% vs 9.9%), mechanical ventilation (2.2% vs 11.3%), emergency care (13.5% vs 40.8%), and intensive care unit protection (2.2% vs 11.3%). From the effect of hospice-shared care on quality of life: (1) Among the 36 terminal cancer patients, there was no significant change in the overall and four domains of quality of life, including physical, psychological, spiritual and social support within the seven weeks before dying. Among four domains, the social support is the best, followed by the physical and psychological domains, and the worst is the spiritual domain. (2) In every week, there was no significant difference in the overall and four domains of quality of life whether patients received hospice-shared care or not. (3) The pre- and post- quality of life among patients who have received hospice-shared care didn’t change significantly too.
Conclusions: In Taiwan, it has been showed to be effective in reducing invasive medical treatment after more than a decade of promotion of terminal cancer patients receiving hospice-shared care. However, there were still 43.8% of terminal patients receiving hospice-shared care belonged to late referral and the effect of hospice-shared care on quality of life still need to be investigated. In the future, a thorough education is crucial to clinical nurse, including the timing of hospice-shared care referred, the management of terminal symptoms, and mental support related courses. Combined with other medical teams, we can achieve the goal of improving overall care quality for terminal cancer patients.
|
|---|
