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  • The distribution of the types of cancer is also

    2019-04-23

    The distribution of the types of cancer is also interesting. Theoretically, the type of cancer should not have impact on a patient\'s place of death, and the rate should be approximately the same in both groups. However, a previous population-based study in Taiwan reported that respiratory tract cancer was a predictor for dying at home. In this study, patients with IDD had relatively higher rates of gastrointestinal/peritoneal cancer and pulmonary cancer, although the differences did not achieve statistical significance. The reason for these findings is unclear, although it may be due to more severe conditions, advanced age, and different referral times in those with specific types of cancer. Further investigations are warranted to elucidate this issue. In this study, most cancer patients were treated at family medicine and oncology/hematology departments, and included more patients with IDD than those who died in a hospice. These two departments are more familiar with both hospice care and supporting IDD. Other departments also promoted the choice of IDD for terminal cancer patients after hospice care (Table 4). Paradoxically, protease inhibitors hiv oncology was the first department to introduce hospice care in Taiwan, however, it had a higher rate of patients dying in hospice rather than with IDD. The possible reasons may be that palliative radiotherapy prolongs life and hospital stay, and reduces late referrals. The lower availability of palliative home care service may also be a factor. A study conducted in central Taiwan reported that palliative home care allowed more terminal patients to die at home. However, radiation oncology provides hospice ward care combined with palliative radiotherapy, which may influence the actual place of death for terminal cancer patients. Compared with the DOH/municipal hospitals, the religious corporation hospitals had the highest positive OR for patients with IDD. A possible reason for this is that religious corporation hospitals place great emphasis on hospice care, providing more hospice home care and more spiritual care workers for terminal patients, and promote public education about palliative care. The negative correlation of IDD with oropharyngeal cancer, bone/connective tissue/breast cancers, and metastatic cancers may reflect difficulties in palliative home care for these cancers, such as wound management, feeding, and pain control. A longer hospice stay may also reflect similar difficulties, especially for those with terminal oropharyngeal cancer who had the longest mean hospice stay (12.9±12.5 days). The correlation between male sex and dying in a hospice may reflect gender-specific types of cancer and the male predominance in certain groups (such as veterans). Professional training for palliative home care and relevant education for patients\' families may overcome these issues. In this study, there was a trend of decreasing percentage of patients who received care in a hospice. Unlike the patients who died in a hospice, the increase of percentage in patients with IDD slowed following the third quaternary of 2009. A British systemic review suggested that good community engagement and increased caring and social networks are beneficial to improve outcomes and preferred places of death for terminal patients. Such experience reinforces the need for palliative home care in Taiwan, and the promotion of dying at home for cancer patients receiving care at a hospice.
    Acknowledgments The authors wish to thank the NHRI for the permission and authorization to utilize the data set. This study does not represent the official viewpoints of the NHRI, R.O.C. (Taiwan). This study was supported by a grant from the National Yang-Ming University Hospital (RD2016-012).
    Introduction For acute critically ill patients visiting the emergency department (ED), initial resuscitation and stabilization, followed by continuously provided specific critical care treatment are mandatory in modern medical systems. ED visits increasing, and the challenges of ED care are numerous, including overcrowding, increased length of stay (LOS) and boarding time, even leading to some critically ill patients receiving delayed admission to the intensive care unit (ICU). Increased hospital LOS and higher ICU and hospital mortality are associated with delayed transfer of critically ill patients from the ED to the ICU. Therefore, providing a continuously high quality of critical care to manage acute critically ill patients from ED visits through ICU care is one of the core contents of emergency medicine practice.