Potential benefits of palliative care for polysymptomatic patients with late-stage nonmalignant disease in Taiwan.
OBJECTIVE
Taiwan is only now beginning to offer palliative care to patients who do not have cancer. This study aimed to document the polysymptomatic presentation of illness in Taiwanese patients with late-stage nonmalignant disease and to evaluate the potential benefits of palliative care for these patients. The results may help to educate healthcare personnel regarding the need for and importance of palliative treatment as comprehensive, appropriate end-of-life care for patients with nonmalignant disease.


METHODS
We retrospectively analyzed 115 patients without cancer hospitalized in a community hospital in Taiwan: 61 had organic brain disease, 31 had chronic obstructive pulmonary disease, 17 had chronic renal failure, 14 had congestive heart failure, 12 had liver cirrhosis, and 20 had multiple illnesses. The median age was 81 years (interquartile range 69-86 years), and 51% of patients were enrolled from intensive care. Symptoms and their severity were analyzed. Patients' and their families' understanding of the diagnosis and prognosis and "Do Not Resuscitate" (DNR) consent were evaluated pre- and post-palliative care.


RESULTS
The four leading symptoms were fatigue (96%), fever (86%), cough (81%), and dyspnea (79%). No significant differences in symptom prevalence were found between different sexes, ages, performance statuses, ward locations, or underlying diseases, except for fewer episodes of dizziness, more frequent episodes of cough in patients older than 80 years, and more episodes of jaundice in ward service subjects. Only the presence of abdominal distension differed significantly between surviving and deceased patients (22.9% vs. 40.3%; p=0.004). After the start of palliative care, patients' DNR consent increased (105/115 before, 114/115 after). Patients' recognition of the diagnosis and prognosis increased from 13 to 64, respectively, with a simultaneous increase in family members' recognition (66 before, 114 after).


CONCLUSIONS
Hospice care with good symptom control is warranted for patients with late-stage nonmalignant disease who need appropriate end-of-life care. Medical personnel need education in the importance of palliative care and the identification of patients who could benefit from it. In addition, patients should be informed of its availability.
Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University, Taoyuan, Taiwan; Saint Peter's Palliative Care Team, Saint Paul's Hospital, Taoyuan, Taiwan.
Yu-Shin
YS
Hung
Chun-Hao
CH
Chen
Kun-Yun
KY
Yeh
Hung
H
Chang
Yun-Chin
YC
Huang
Chen-Ling
CL
Chang
Wei-Shan
WS
Wu
Hai-Pei
HP
Hsu
Jin-Chen
JC
Lin
Wen-Chi
WC
Chou
D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000150:complications; D003371:Cough / Q000209:etiology / Q000628:therapy*; D004417:Dyspnea / Q000209:etiology / Q000628:therapy*; D005221:Fatigue / Q000209:etiology / Q000628:therapy*; D005260:Female; D005334:Fever / Q000209:etiology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D010166:Palliative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D051436:Renal Insufficiency, Chronic / Q000150:complications; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013624:Taiwan; D013727:Terminal Care
hospice care; late-stage nonmalignant disease; palliative care; polysymptomatic presentation of illness