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  • Association of advance care planning with place of death and utilisation of life-sustaining treatments in deceased patients at Taipei City Hospital in Taiwan

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Original research
Association of advance care planning with place of death and utilisation of life-sustaining treatments in deceased patients at Taipei City Hospital in Taiwan
  1. Yung-Feng Yen1,2,3,4,5,
  2. Ya-Ling Lee5,6,7,
  3. Hsiao-Yun Hu2,4,5,
  4. Wen-Jung Sun8,9,10,11,
  5. Ming-Chung Ko3,5,12,
  6. Shen-Shong Chang2,13,14,
  7. Chu-Chieh Chen3,
  8. Sheng-Jean Huang15,16 and
  9. Dachen Chu2,3,5,15
  1. 1 Section of Infectious Diseases, Taipei City Hospital Yangming Branch, Taipei, Taiwan
  2. 2 Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
  3. 3 Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
  4. 4 Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
  5. 5 University of Taipei, Taipei, Taiwan
  6. 6 Department of Dentistry, Taipei City Hospital, Taipei, Taiwan
  7. 7 Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
  8. 8 Department of Community Medicine, Taipei City Hospital, Taipei, Taiwan
  9. 9 Center of Research and Development in Community Based Palliative Care, Taipei City Hospital, Taipei, Taiwan
  10. 10 Holistic Mental Health Center, Taipei City Hospital, Taipei, Taiwan
  11. 11 Community Medicine Department & Family Medicine Division, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan
  12. 12 Department of Urology, Taipei City Hospital, Taipei, Taiwan
  13. 13 Division of Gastroenterology, Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan
  14. 14 School of Medicine, National Yang-Ming University, Taipei, Taiwan
  15. 15 Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan
  16. 16 Department of Surgery, Medical College, National Taiwan University Hospital, Taipei, Taiwan
  1. Correspondence to Dr Yung-Feng Yen, Section of Infectious Diseases, Taipei City Hospital Yangming Branch, Taipei 10341, Taiwan; yfyen1{at}gmail.com

Abstract

Objective Evidence is mixed regarding the impact of advance care planning (ACP) on place of death. This cohort study investigated the effect of ACP programmes on place of death and utilisation of life-sustaining treatments for patients during end-of-life (EOL) care.

Methods This prospective cohort study identified deceased patients between 2015 and 2016 at Taipei City Hospital. ACP was determined by patients’ medical records and defined as a process to discuss patients’ preferences with respect to EOL treatments and place of death. Place of death included hospital or home death. Stepwise logistic regression determined the association of ACP with place of death and utilisation of life-sustaining treatments during EOL care.

Results Of the 3196 deceased patients, the overall mean age was 78.6 years, and 46.5% of the subjects had an ACP communication with healthcare providers before death. During the study follow-up period, 166 individuals died at home, including 98 (6.59%) patients with ACP and 68 (3.98%) patients without ACP. After adjusting for sociodemographic factors and comorbidities, patients with ACP were more likely to die at home during EOL care (adjusted OR (AOR)=1.71, 95% CI 1.24 to 2.35). Moreover, patients with ACP were less likely to receive cardiopulmonary resuscitation (AOR 0.36, 95% CI 0.25 to 0.51) as well as intubation and mechanical ventilation support (AOR 0.54, 95% CI 0.44 to 0.67) during the last 3 months of life.

Conclusion Patients with ACP were more likely to die at home and less likely to receive life-sustaining treatments during EOL care.

  • end of life care
  • hospice care

Data availability statement

Data are available on reasonable request. This prospective cohort study analysed the palliative data at Taipei City Hospital. All information that allows a specific individual patient to be identified was encrypted. After encryption of the data, we collected patients’ demographics, comorbidities, place of death and life-sustaining treatments during EOL care.

https://doi.org/10.1136/bmjspcare-2020-002520

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    Data availability statement

    Data are available on reasonable request. This prospective cohort study analysed the palliative data at Taipei City Hospital. All information that allows a specific individual patient to be identified was encrypted. After encryption of the data, we collected patients’ demographics, comorbidities, place of death and life-sustaining treatments during EOL care.

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    Footnotes

    • Y-FY, Y-LL and H-YH contributed equally.

    • Contributors Y-FY, Y-LL, H-YH, W-JS, M-CK, S-SC, C-CC, S-JH and DC substantially contributed to the conception and design of the study, data analysis, data interpretation and the drafting of the manuscript. Y-FY, Y-LL, H-YH, W-JS, M-CK, S-JH and DC substantially contributed to data acquisition and interpretation of the results. Y-FY, Y-LL, H-YH, W-JS, M-CK, S-SC, C-CC, S-JH and DC all approved the final version of the manuscript.

    • Funding This study was supported by a grant from the Department of Health, Taipei City Government, Taiwan.

    • Disclaimer The study sponsor was not involved in the study design, the collection, analysis, or interpretation of the data, the writing of this report, or the decision to submit it for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.