| Summary: | 碩士 === 國立雲林科技大學 === 健康產業管理研究所碩士班 === 99 === The concept of palliative care has not been widely accepted in Taiwan. Therefore, health care providers in the emergency rooms (ER) usually face a dilemma in managing patients who are residents of long-term care institutes in choosing active resuscitation or supportive care at the terminal stage of their life. The objective of this study was to evaluate the characteristics of the long-term care residents and their demands to receive palliative care in the ER setting. Methods is The patients who were residents of long-term care institutes and sent to the ER of study hospital were included. Background characteristics and clinical data were recorded, and a “palliative score demand evaluation questionnaire” was provided to collect information about the functional status of the patients. The information was linked to prognosis and survival data one year later. A total of 61 patients were included in the analysis (35men and 26women, mean age 73.18±13.81). The most frequent diagnoses were pneumonia (48.3%), urinary tract infection (20.7%), and bed sore (54.1%). Fifty patients (82%) required more than one admission. All the “Do Not Resuscitation” (DNR) consent was signed by the family, and none of the DNR was approved by the patients themselves at the long-care institutes. A total of 25 patients (41%) died in the following 6 months to one year. The score in the evaluation questionnaire was positively associated with the mortality rate.The “palliative score demand evaluation questionnaire”score was use to discriminate 1year survival with an area under curve 0.75 in the ROC analysis.The results showed the ignorance and lack of acceptance of hospice care by the residents in long-care institutes and their family. Intervention by the health care providers in the ER and Long- term Care Institutions setting may possibly enhance the awareness to this problem.
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