title: Impact of Palliative Care Consultation Service on Terminally Ill Cancer Patients: A 9-Year Observational Cohort Study in Taiwan.
abstract: The palliative care consultation service (PCCS) that has been enthusiastically promoted in Taiwan since 2005 was designed to provide comprehensive end-of-life care for terminally ill patients with qualified interdisciplinary specialists in acute care ward setting. This study aims to evaluate the impact of PCCS on terminally ill cancer patients.A total of 10,594 terminal cancer patients who were referred to PCCS from a single medical center in Taiwan between 2006 and 2014 were enrolled. The percentages of patients' and their families' disease awareness, do-not-resuscitate (DNR) designation, refusal and acceptance of palliative care among terminally ill cancer patients were analyzed retrospectively.At the beginning of PCCS, the percentages of disease awareness among patients and their family were increased from 25.4% to 37.9% (P = 0.007) and from 61.2% to 84.7% between 2006 and 2014 (P = 0.001), respectively. Patients' disease awareness after PCCS referral between 2006 and 2014 was increased from 47.1% to 64.5% (P = 0.016). Family's awareness of diagnosis and prognosis after PCCS referral researched to a steady plateau, 94.1% to 97.8% in different year cohort (P = 0.34). The percentage of DNR designation rate at the beginning of PCCS (in 2006) was 15.5%, and the designation rate was increased annually and finally reached to 42.0% in 2014 (P = 0.004). The percentage of DNR consents after PCCS was also improved from 44.0% in 2006 up to 80.0% in 2014 (P = 0.005). PCCS refusal rate decreased gradually and dropped to 1.6% in 2014 (P = 0.005). The percentage of PCCS utilization was increased 5-fold during the 9-year period after the promotion of PCCSIn the program of PCCS promotion, an increasing trend of PCCS utilization, better patients' and their families' awareness of diagnosis and prognosis, more consent to DNR, more patients were discharged with stable condition at the end of PCCS and a decrease refusal rate of end-of-life palliative care among terminal cancer patients were observed in Taiwan between 2006 and 2014.
authors.affiliation: From the Department of Nursing (C-YL, S-CT, T-LC, C-CC, J-MY, C-WC, Y-FL, Y-CY), Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou (W-CS, C-YK, H-MW, Y-SH, W-CC), and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan (W-CC).
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Lu
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Shen
authors.forename: Chen-Yi
authors.initials: CY
authors.lastname: Kao
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.forename: Shu-Chuan
authors.initials: SC
authors.lastname: Tang
authors.forename: Tsu-Ling
authors.initials: TL
authors.lastname: Chin
authors.forename: Chuan-Chuan
authors.initials: CC
authors.lastname: Chi
authors.forename: Jin-Mei
authors.initials: JM
authors.lastname: Yang
authors.forename: Chih-Wen
authors.initials: CW
authors.lastname: Chang
authors.forename: Ying-Fen
authors.initials: YF
authors.lastname: Lai
authors.forename: Ya-Chi
authors.initials: YC
authors.lastname: Yeh
authors.forename: Yu-Shin
authors.initials: YS
authors.lastname: Hung
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
mesh_terms: D015331:Cohort Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010166:Palliative Care; D012017:Referral and Consultation; D013624:Taiwan; D019452:Terminally Ill