A Study on the Development of an Assessment Tool for the Early Palliative Consultation Needs - Based on a Regional Teaching Hospital

• Main Authors: LIN, HONG-MAU, 林宏茂
• Other Authors: CHENG,BOR-WEN
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/wkav63

博士 === 國立雲林科技大學 === 工業工程與管理系 === 106 === In the past decades, the awareness of "good death" has gradually risen, but there were no appropriate opportunities to talk about "Do Not Resuscitate" (DNR). At present, the end-of-life care is still hospital-based in Taiwan. The current practice by hospice wards alone are not enough to achieve this task, so it is better to establish a hospital-based palliative care model. All units of a hospital should be able to take care of dying patients and their families. Even if the palliative care has been extended from the hospital to the community, care workers are still trained under hospital-based program. Regardless of causes, all end-of-life patients should receive high-quality end-of-life care. The purpose of this study was to develop an assessment tool (Palliative Consultation Care Screening Tool_ PCCST) to identify the end-of-life patients early, so that early consultation could be initiated to facilitate patient assessment and meet advanced care plan. In this study, we prospectively enrolled 27,141 hospitalized patients from January 1, 2010 to December 30, 2011. PCCST scores were assessed at admission of the patient by junior and senior staffs independently. The collected data were analyzed by SPSS software statistics, descriptive analysis, paired T test, chi-squared test and Pearson's correlation, ROC curve analysis, linear regression and Logistic regression were applied. After a follow-up period of 6 years 6 months, a total of 3,818 enrolled cases died, and the cores from PCCST correlated well with the mortality rate. The mortality rate was 37.5% (214/570) for the patients with the score 8 points or higher. ROC curve showed the optimal cut of point for the possibility of death at score 1.5 points(area：0.701, Youden’s index (YI) =0.316). The optimal cut of point for the possibility of end-of-life at PCCST score 3.5 (area：0.660, YI=0.242). Risk factors of “the possibility of death” included male sex (odds ratio： male vs. female 1.39-1.40), age (odds ratio：1.02) and PCCST score (odds ratio 1.26-1.29). Risk factors of “the possibility of end-of-left” included sex (odds ratio： male vs. female 1.24), and PCCST score (odds ratio: 1.29). The prediction equation of life expectance when the patient died is “life expectancy (days) =515.509+ (-41.313) *score (senior staff). Despite that there were 570 cases with PCCST scores 8 points or higher, only 27 of their physician agreed with palliative consultation. Conclusion： According to the results, the PCCST can be used as a suitable tool for end-of-life assessment, and helps identify end-of-life patients early. There were no significant differences between junior versus senior staffs. The tool is use-friendly and could be extended to emergent room or home care.