The effects of hospice-shared care for gastric cancer patients.
BACKGROUND
Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients.


METHODS
A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81).


RESULTS
Among the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, p<0.001), intubation (1% vs 27%, p<0.001), cardiopulmonary-cerebral resuscitation (0% vs 11%, p = 0.001), ventilator use (1% vs 27%, p<0.001), inotropic agent use (8% vs 46%, p<0.001), total or partial parenteral nutrition use (38% vs. 58%, p = 0.029), and blood transfusion (45% vs 74%, p<0.001). Besides, the hospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR) orders (95% vs 37%, p<0.001), receiving home hospice care (16% vs 1%, p<0.001), and indicating home as the realistically preferred place of death (41% vs 19%, p = 0.001). The hospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014.


CONCLUSIONS
The use of hospice-shared care for gastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life.
Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Kun-Siang
KS
Huang
Division of General surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Shih-Ho
SH
Wang
Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.|Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Seng-Kee
SK
Chuah
Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.|Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Kun-Ming
KM
Rau
Division of General surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Yu-Hung
YH
Lin
Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.|Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Meng-Che
MC
Hsieh
Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.|Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Li-Hsueh
LH
Shih
Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.|Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Hospice care team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Yen-Hao
YH
Chen
D000368:Aged; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006738:Hospices / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data; D011788:Quality of Life; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013274:Stomach Neoplasms; D013727:Terminal Care / Q000706:statistics & numerical data