Authors (including presenting author) :
Lum MYA (1), Kwong MK(1), Ng PSP(1), Hung YKS(1), Ng LY(1), Kwong MC(1), Tai MYM (1), Chan YLH(2)
Affiliation :
(1)Central Nursing Division, QEH (2) The Nethersole School of Nursing, Faculty of Medicine, CUHK
Introduction :
Given that palliative care is vital to optimize the care outcomes of seriously ill patients, a Shared Care Model with curative treatment and palliative care provided in parallel has been introduced in the Queen Elizabeth Hospital since 2012.
Objectives :
To compare (1) the pattern of healthcare utilization, and (2) end-of-life care in the last 12 months of life between patients with or without the support of shared care model.
Methodology :
This was a retrospective study of 300 deceased cases in the medical department meeting the criteria of Supportive and Palliative Care Indicators in Jan-Jun 2018 were included for analysis. The medical records were retrieved and reviewed to collect data about their demographic characteristics, health conditions, hospital resource use, and end-of-life care planning. SPSS version 25.0 was used for data analysis. Descriptive statistics was used to describe the characteristics of patients. Chi square test or independent t-tests were used to compare the differences. All data were collected on anonymous basis. Ethical approval for the study was obtained from the Research Ethics Committee.
Result & Outcome :
Among the 300 reviewed cases, the mean age of the patients was 80.7 (SD 12.7) years, ranging from 25 to 106. The proportion of male (53.2%) to female (46.8%) was similar. Their average number of hospital admission in the last 12 months of life was 4.0 (SD 4.3), ranging from 1 to 45. The mean length of stay was 45.0 (SD 45.5) days. Around one-third of them remained conscious and alert in the last episode of hospitalization. The DNACPR order was placed in the medical record for most of them (79.1%), but documentation of involvement of patients and family in the end-of-life care planning was only 5.0% and around 50% respectively. Only 3 patients signed an advance directive. Only 38.2% received palliative care. Referral date was generally late, within the last 2 weeks of life with a median of 2 days. Cancer patient had a higher chance of accessing to palliative care. AED attendances were significantly lower in patients who had been referred to palliative care services (p< 0.01). The proportion of receiving CPR was significantly lower among patients who had been referred to palliative care services (32.8% vs 10.4%, p< 0.001). Besides, patients being referred to palliative care had a higher chance to receive antidepressants/anxiolytics (p=0.035) and sedatives/hypnotic medication (p=0.001).
