title: Impact of combined hospice care on terminal cancer patients.
abstract: BACKGROUND
  Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system.
  
  
  METHODS
  From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed.
  
  
  RESULTS
  A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% (p < 0.0001), and awareness of disease prognosis from 46.05% to 57.69% (p = 0.0006). Combined hospice care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%).
  
  
  CONCLUSIONS
  Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.
authors.affiliation: Department of Family Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. loke@adm.cgmh.org.tw
authors.forename: Song-Seng
authors.initials: SS
authors.lastname: Loke
authors.forename: Kung-Ming
authors.initials: KM
authors.lastname: Rau
authors.forename: Chih-Fang
authors.initials: CF
authors.lastname: Huang
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D013624:Taiwan; D013727:Terminal Care; D016896:Treatment Outcome