RT Journal Article
SR Electronic
T1 Hospice delivery models and survival differences in the terminally ill: a large cohort study
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP e1134
OP e1143
DO 10.1136/bmjspcare-2021-003262
VO 14
IS e1
A1 Lai, Wei-Shu
A1 Liu, I-Ting
A1 Tsai, Jui-Hung
A1 Su, Pei-Fang
A1 Chiu, Pin-Hsuan
A1 Huang, Ying-Tzu
A1 Chiu, Ge-Lin
A1 Chen, Yu-Yeh
A1 Lin, Peng-Chan
YR 2024
UL http://spcare.bmj.com/content/14/e1/e1134.abstract
AB Objective A common difficulty at the end of life (EOL) is to determine an appropriate service model, such as hospice share care (HSC), hospice inpatient care (HIC) and hospice home care (HHC). This study aimed to recommend the appropriate hospice delivery model based on the physical, psychosocial and spiritual needs of patients referred for hospice care.Methods This cohort study included patients who received only one kind of hospice delivery model between 2006 and 2020. Data were analysed with descriptive statistics, Fisher’s exact test, non-parametric analysis of variance, Kaplan-Meier curves and Cox proportional hazards model that determined the patients’ clinical characteristics for a hospice delivery model and overall survival.Results A total of 8874 hospice patients were recruited, of which 7076 (79.7%) were HSC patients, 918 (10.4%) were HIC patients and 880 (9.9%) were HHC patients. There were significant differences in the physical symptoms and demographic, psychosocial and spiritual factors among the three groups (p<0.001). The patients who received the HHC were less to have dyspnoea (18.5%) and dysphagia (28.7%). The HIC patients showed higher severity of symptoms and experienced greater psychosocial distress (73.2%). The HSC is appropriate for noncancer patients . Patients with cancer were associated with less dyspnoea (32.4%) and dysphagia (46.5%). Patients with lung cancer who received the HHC had better survival than those who received other types of hospice care (HR=0.75, 95% CI: 0.66 to 0.86, p<0.001).Conclusions This study provides guidance regarding the appropriate hospice service model, based on individualised palliative needs, targeting improvement in EOL care.All data relevant to the study are included in the article or uploaded as supplementary information. The data are deidentified participant data from Hospice Databank of NCKUH.