Characteristics of Palliative Patients, Insights of Patients and Families, and the Impact of Estimated Survival Time on Therapy Decisions

Hamzah Shatri, Rudi Putranto, Cosphiadi Irawan, Mizanul Adli, Dina Elita

Abstract


Background: chronic and terminal diseases require holistic therapy that covers the biopsychosocial aspect, and it can be found in palliative therapy. Patients who receive palliative therapy exhibit very diverse profiles. As such, researchers are keen to study the general characteristics of palliative patients. In addition, researchers will also assess the patient’s and their family’s insight that influences the success of the therapy and the impact of estimated survival time in making treatment decisions. Methods: this research used cross-sectional descriptive analytic study and secondary data of 300 palliative patients who consult to Psychosomatic Palliative Team at Dr. Cipto Mangunkusumo Hospital. The data were processed using SPSS version 25. The data processed included: sociodemographic characteristics, length of stay, incidence of death in hospital, DNR cases, the patient’s and their family’s insight, and the impact of estimated survival time on treatment decisions. Results: most palliative patients were women (52.0%) aged 51 - 60 years (27.0%), unemployed (29.0%), and suffered from cancer (55.3%). In addition, the patients were generally treated for less than 1 month (83.6%), died in the hospital (37.3%), and consented to DNR orders (36.7%). These DNR cases are highly correlated to the family’s understanding regarding the prognosis of the patient’s condition (p = 0.022). The family’s understanding of the diagnosis, prognosis, and treatment goals (92.3%, 81.3%, and 87.7%) was better than the patient’s (79.0%, 64.0%, and 69.7%). Furthermore, no link was found between the therapy choice (optimal, withholding, and withdrawing therapies) with the patient’s estimated survival time (p = 0.174). Conclusion: female, elderly, and cancer patients most often get palliative therapy. The consent for DNR orders to palliative patient is notably frequent. Currently, the family’s insight is much better than the patient’s, which means that health care providers need to improve patient education and information. In addition, patients and families generally still opt for optimal therapy despite low estimated survival time.

Keywords


Characteristics; do not resuscitate (DNR); Insight; Palliative; Therapy Options

References


Phaswana-Mafuya NR, Davids A, Tassiopoulos D. Non-communicable diseases (NCDs) in developing countries. Chapter 1: Epidemiology of chronic non-communicable disease in low and middle income countries – a review. New York: Nova Science Publisher, Inc. 2011. p. 1-38.

May P, Normand C, Morrison RS. Economic impact of hospital inpatient palliative care consultation: review of current evidence and directions for future research. J Palliative Med. 2014;17(9):1054-63.

Deter HC. Psychosocial interventions for patients with chronic disease. Bio Psycho Social Med. 2012;6(2):1-5

Yang N, Ornstein KA, Reckrey JM. Association between symptom burden and time yo hospitalization, nursing home placement, and death among the chronically il urban homebound. J Pain Symptom Management. 2016;52(1):73-80

Schofield D, Shrestha RN, Cunich MM, et al. Economic costs of chronic disease through lost productive life years (PLYs) among Australians aged 45-64 years from 2015 to 2030: results from a microsimulation model. BMJ Open. 2016;6(9):1-9.

Farre L, Fasani F, Mueller H. Feeling useless: the effect of unemployment on mental health in the great recession. Barcelona Graduate School of Economic. 2015;1-26.

Sawhney M, Fletcher GG, Rice J, Watt-Watson J, Rawn T. Guidelines on management of pain in cancer and/or palliative care. Toronto (ON): Cancer Care Ontario. 2017. Program in Evidence-Based Care Evidence Summary No.:18-4.

World Health Organization. WHO definition of palliative care. https://www.who.int/cancer/palliative/definition/en/.

Jack B, Hillier V, Williams A, Oldham J. Hospital based palliative care teams improve the insight of cancer patients into their disease. Palliative Med. 2004;18:46-52.

Goodwin K. Improving women’s health: state policy options. National Conference of State Legislatures. 2015:1-11.

Turabian JL. Gender differences in prevalence of chronic disease: facts and hypothesis; melody and harmony. J Public Health General Med. 2018;1(1):1-3.

Gabriele L, Buoncervello M, Ascione B, Bellenghi M, Matarrese P, Care A. The gender perspective in cancer research and therapy: novel insights and on-going hypotheses. Ann Ist Super Sanita. 2016;52(2):213-22.

John P, Ghooi RB. Profile of patients opting for palliative care in India. Indian J Palliative Care. 2017;23(4):451-5.

Stiel S, Heckel M, Seifert A, Frauendorf T, Hanke RM, Osgathe C. Comparison of terminally ill cancer- vs non-cancer patients in specialized palliative home care in Germany – a single service analysis. BMC Palliative Care. 2015;14(34):1-7.

Bannon M, Dionne-Odom J, Arnold R, Zimmermann C, Kavalieratos D. Comparison of palliative care interventions for cancer vs non-cancer patients: a secondary analysis of a systematic review. Scientific Poster Abstract. 2018;55(2):673.

Veloso VI, Tripodoro VA. Caregivers burden in palliative care patients: a problem to tackle. Curr Opin Support Palliat Care. 2016;10(4):330-5.

Australian Institue of Health and Welfare. Admitted patient palliative care and hospital-based facilities. Palliative Care Services in Australia. 2015:1-14.

Dincer M, Kahveci K, Doger C. An examination of factors affecting the length of stay in a palliative care center. J Palliative Med. 2017;1-5.

Murray SA, Kendall M, Mitchell G, Moine S, Novellas JA, Boyd K. Palliative care from diagnosis to death. BMJ. 2017;356:878.

Nowarska A. CPR vs DNR in the context of palliative care. Adv Palliative Med. 2011;10(3-4):89-94.

Eckerblad J. Symptom burden among people with chronic disease. Linkoping University Medical Dissertations No. 1484. 2015:1-97.

O’Connor M, White K, Kristjanson LJ, Cousins K, Wikes L. Med J Aust. 2010;193(5Suppl):S44.

Da Silva RS, Trindade GSS, Paixao GP, Silvia MJP. Family conference in palliative care: concept analysis. Rev Bras Enferm. 2018;71(1):206-213.

Cheng YH, Wang JJ, Wu KH, Huang S, Kuo ML, Su CH. Do-not-resuscitate orders and related factors among family surrogates of patients in the emergency department. Support Care Cancer. 2015:1-8.

Sudore RL, Casarett D, Smith D, Richardson DM, Ersek M. Family involvement at the end-of-life and receipt of quality care. J Pain Symptom Manag. 2014;48(6):1108-16.

Smith CB, O’Nell LB. Do not resuscitate does not mean do not treat: how palliative care and other modalities can help facilitate communication about goals of care in advanced illness. Mount Sinai J Med. 2008;75:460-5.


Full Text: PDF

Refbacks

  • There are currently no refbacks.


Copyright (c) 2019 Acta Medica Indonesiana