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Background: Enabling people to die in their preferred place is important for providing high-quality end-of-life care. Objective: The study objective was to explore patients' preferences regarding the place of end-of-life care and death and to compare these preferences with the perceptions of their family physicians. Methods: This cross-sectional study used stratified random sampling, surveying 400 registered patients and 200 of their family physicians nationwide, with a five-part, structured, self-report questionnaire. Results: Of the selected population, 310 patients (response rate 77.5%) and 169 physicians (response rate 84.5%) responded. Regarding the preferred place for end-of-life care, most of the patients would choose to receive care at home (60.6%) if home care services were available. Additionally, home was the most frequently preferred (66.5%) place of death. The family physicians' survey showed that a higher proportion of physicians selected home as the preferred place for end-of-life care and death (71.6% and 87.2%, respectively). The results of logistic regression analysis showed that patients younger than 50 years of age who believed in Chinese folk religion and who resided in a rural area were more likely to prefer to die at home. Conclusions: The most commonly preferred place for end-of-life care and death is the patient's home. Establishing a community-based palliative care system should be encouraged to allow more individuals to die in their preferred locations. There were discrepancies in the preferred place of end-of-life care and death between the patients' preferences and their family physicians' perceptions. More effective physician-patient communication regarding end-of-life care is needed. [ABSTRACT FROM AUTHOR]

Background: Achieving a good death is the ultimate goal of palliative medicine. Yet, very few studies have investigated factors affecting improvement in quality of dying. We therefore conducted a study to evaluate these factors in terminally ill Taiwanese cancer patients treated in a multidisciplinary palliative care unit. Methods: We included data from terminally ill patients with cancer admitted to the Hospice and Palliative Care Unit in the National Taiwan University Hospital from 2000 to 2009. Quality of dying was assessed by patients' multidisciplinary team at admission and after death using the Good Death Scale and the Audit Scale. We used multivariable regression to assess the association between patient factors, including gender, age, diagnosis, days of hospitalization, calendar year of admission, Good Death score at admission, and process of care scores for physical care, physician-assessed autonomy, emotional support, communication, continuity of life, and physician-reported rate of closure, with the quality of dying. Results: Multivariate regression analysis identified lower Good Death score at admission, lower age 40-65 years, longer unit length of stay (>7 days), higher physician-assessed autonomy, better physician-assessed emotional support, and better physician-reported rate of closure as positively related (all p<0.0001) with improvement in good death scores. Conclusion: In this study in a Taiwanese palliative care unit; we found that late referral to the unit and low physician-assessed autonomy were key factors negatively affecting quality of dying. Earlier truth-tellling and end-of-life care discussions between physicians and patients might improve the quality of dying in this population. [ABSTRACT FROM AUTHOR]

Background: Antibiotic administration is frequent in terminal patients with cancer, yet the effects on survival are still under debate. Objective: The aim of this study was to examine the status of infection and the benefit/burden of antibiotic administration on the survival of terminal patients with cancer with infection. Design: A prospective observational study. Setting/Subjects: We studied 799 patients with terminal cancer who were admitted to a palliative care unit in Taiwan between January 2008 and the end of April 2010. Survival was calculated from the first day of admission to the day of death in the palliative care unit or under home care. Measurements: A specially designed assessment tool was used daily to evaluate clinical conditions. Afterwards, it was analyzed at different time points in a weekly team meeting. Multivariate Cox proportional hazard analyses were used to examine the benefit/burden of antibiotic administration on survival. Results: Four hundred fifty-five patients were diagnosed as having at least one episode of infection after first admission. A total of 295 of the 378 (78.0%) with infection received antibiotic treatment upon admission. Multivariate Cox proportional hazard analyses showed that antibiotic administration was related to improved survival for patients who were still alive 1 week after admission (hazard ratio: 0.66, 95% confidence interfal [CI]: 0.46-0.95). However, antibiotics would be a hazard to patients' survival if used in the time 2 days prior to death (hazard ratio: 1.54, 95% CI: 1.22-1.94). Conclusions: The results suggest that with good communication between patients, families, and medical staff, withdrawal of antibiotics should be considered if signs of death appear, in order to avoid unnecessary risks. The possible benefit of prolonged survival should be in line with the goal of care, and also take into account preparing the patient for a dignified death. [ABSTRACT FROM AUTHOR]

Background: Fatigue is a multidimensional phenomenon that has different meanings according to different societal and cultural settings. This study aims to decipher fatigue in Taiwanese patients with cancer. Methods: We recruited 440 patients with advanced cancer admitted consecutively to the palliative care unit of a major medical center in Taiwan. The data were collected at admission, 1 and 2 weeks after admission, and 2 days before death. Results: The subject group consisted of 51.8% males and 48.2% females with a median age of 67 years (ranging from 27 to 93 years). The leading primary tumor sites among these patients were lung (20.2%), liver (18.0%), and colon-rectum (10.7%), and the median survival was 15 days, with a range of 1 to 418 days. All symptoms improved 1 week after admission, but most of them significantly worsened 2 days before death. In general, the physical signs manifested variation patterns similar to those of symptoms. The severity of psychosocial distress and death fear was lower after admission and retained the same level at 2 days before death, defying the consistent patterns found in other symptoms and signs. In the correlation analysis, most symptoms were correlated with fatigue during admission, with weakness being the most significant one. Although self-efficacy and emotion were correlated with fatigue both on admission and 1 week after admission, social support and death fear were not correlated with fatigue at all times. Conclusion: The meaning of fatigue is mainly associated with physical factors among these patients. Education of complexities in fatigue in tandem with psychosocial and spiritual care may help alleviate this symptom, and promote quality of life. [ABSTRACT FROM AUTHOR]

Purpose: To explore the factors that influence the willingness of junior doctors to provide palliative care in future clinical practice and to evaluate the effect of palliative care education in ameliorating these factors. Methods: A 2-week clinical training course consisting of clinical patient care, multidisciplinary team meetings, home visits, and lecture series was conducted for interns in a palliative care unit of a university hospital. A structured self-report questionnaire was administered before and after the training. Results: One hundred forty-seven interns were enrolled and completed the questionnaire, which demonstrated significant improvements in knowledge and beliefs toward palliative care after the training ( p < 0.001). Although the interns' willingness to provide palliative medical care was influenced by relatives' support before the training (odds ratio [OR] = 3.861, 95% confidence intgerval [CI] = 1.217-12.243), this relationship vanished after training. A higher willingness to provide home visits was noted in participants who received palliative care education at medical school. In contrast, information received from mass media was shown to be negatively correlated with willingness. After the training, the only independent variable that was positively correlated with interns' willingness to provide home visits was their own beliefs on palliative care (OR = 1.074, 95% CI = 1.058-8.089). Conclusions: Educating junior doctors to build positive beliefs toward palliative care is strongly encouraged. Palliative care education contributes to increased junior doctors' willingness toward providing palliative care, which suggests that this kind of training course should be emphasized in medical education. [ABSTRACT FROM AUTHOR]