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The article discusses a study to determine the level of care available for end-of-life patients at intensive care units (ICU) in Taiwan. Researchers looked into data for 204,850 cancer patients between 2001 to 2006, looking into factors such as their demographics, disease, doctors and resources available, and regional levels. They found that ICU care for patients' last month in life did not differ much between 2001 to 2006, that more males around 65 years of age used them, and that those with cancer were less likely to use ICU facilities near death.

Abstract Goals of work  Since emergency departments (ED) are designed to manage people with urgent and life-threatening conditions, cancer patients presenting with pain may not receive the appropriate care in the ED. The purpose of this study was to identify the incidence and factors related to ED visits by cancer patients with pain complaints. Materials and methods  Medical charts selected by stratified random sampling were retrospectively reviewed to obtain information about ED visits by cancer patients during a 1-year period. The sample included 1,179 ED visits by 1,026 cancer patients. Main results  Pain was the most common reason for ED visits by cancer patients. The incidence of ED visits for pain as a presenting problem was 27.8%. The 72-h ED return-visit rate was 8.2% for cancer patients who visited the ED with pain complaints. Patients with gastrointestinal and genitourinary cancers were more likely to visit the ED for pain. Patients who had received radiation therapy were less likely to visit the ED for pain. Conclusion  Effective cancer pain management programs need to be developed and tested to reduce ED visits by cancer patients with pain. More research is needed to explore why cancer patients with pain visit the ED. [ABSTRACT FROM AUTHOR]

Background. Oncologists play a significant role in cancer care throughout the cancer trajectory and have traditionally emphasized underuse of procedures/treatments with well-established effectiveness as the source of poor care quality with little attention to overusing end-of-life (EOL) care. The purpose of this populationbased study was to compare the quality of EOL care between medical oncologists and other physician specialists. Methods. This retrospective cohort study compared indicators of poor quality EOL care by examining administrative data for 204,850 Taiwanese cancer decedents in 2001-2006. Results. Taiwanese cancer patients whose primary physician was a medical oncologist were significantly more likely than patients of other physician specialists to receive chemotherapy and to spend >14 days in a hospital in the last month of life. However, they were significantly less likely than patients of other physician specialists to visit the emergency room (ER) more than once and to use intensive care unit (ICU) care, cardiopulmonary resuscitation (CPR), intubation, and mechanical ventilation in the last month of life. Conclusion. The quality of EOL cancer care in Taiwan varied significantly by physician specialty. Cancer decedents cared for by medical oncologists were more likely to receive chemotherapy and prolonged hospitalization but less likely to have multiple ER visits, ICU care, or undergo CPR, intubation, or mechanical ventilation in the last month of life than patients of other physician specialists. [ABSTRACT FROM AUTHOR]

Family caregivers in East Asian countries are known to have a strong sense of filial piety and a traditional caregiving ideology. They are generally presumed to be protected from psychological distress arising from caregiving. However, there is scant information regarding the impact of caregiving on Chinese/Taiwanese families. The purpose of this study was aimed at identifying those family caregivers of Taiwanese terminally ill cancer patients who are at risk of experiencing depressive distress from the following three categories of predisposing factors: 1) contextual factors; 2) stressors; and 3) appraisal of the caregiving situation. Of the 170 Taiwanese family caregivers of terminally ill cancer patients that participated in this survey, 129 (75.9%) were at an extraordinarily high risk of being distressed because of depressive symptoms (CES-D>15). Results indicated that family caregivers were vulnerable to clinically depressive distress if they were the patient's spouse (adjusted odds ratio (AOR): 2.89; 95% confidence interval (CI): 1.19-7.01), or evaluated caregiving as imposing a greater negative impact on their own health (AOR: 1.27; 95% CI: 1.09-1.47). In contrast, if family caregivers felt very confident in their knowledge of how to take care of the patient at home (AOR: 0.35; 95% CI: 0.15-0.81), or were sufficiently aware of the patient's thoughts and feelings about disease experiences and symptoms (AOR: 0.47; 95% CI: 0.25-0.88), they were less likely to suffer from depressive distress. These finding have significant clinical implications when they are put into the context of Confucian cultures which place great emphasis on filial piety and familism. Interventions and policy should be developed to target spousal caregivers to enhance their confidence in caregiving and understanding of the patient's disease experiences. This will reduce the negative caregiving impact on the caregiver's health, which in turn may prevent the development of depressive distress among family caregivers. [ABSTRACT FROM AUTHOR]

Ovarian cancer represents about 4% of all cancers in women and is the fifth leading cause of death in the United States each year. Ovarian cancer is associated with uncertainty, anxiety, and depression. Many women present with advanced disease at diagnosis and are faced with aggressive surgical and medical protocols to treat them. To meet the needs of women with ovarian cancer, the effects of their physical problems on psychological adjustment must be identified. Health care professionals must closely monitor women with ovarian cancer to identify those who may require ongoing psychological care or psychiatric intervention. This article presents an overview of ovarian cancer, focusing on the psychological effects, and an intervention by oncology nurse specialists to address both the physical and emotional distress that accompanies ovarian cancer. The importance of screening for psychological distress is emphasized. [ABSTRACT FROM AUTHOR]

Caring for an individual at the end of life contributes to psychological distress, physical disease, and increased mortality. The extent of the experienced stress does not depend solely on the demands of the situation. Psychological resources account for a larger part of the variances in caregiver outcomes. To investigate the unique contribution of personal resilience to the experience of depressive distress for family caregivers of Taiwanese terminally ill cancer patients. Stress-process model and Antonovsky's concept of sense of coherence. Cross-sectional survey. 194 caregivers were recruited by a convenience sampling strategy. Predisposing factors of depressive distress were categorized as: (a) caregiver characteristics; (b) demographics and disease-related variables of the patients; (c) objective caregiving loads; (d) subjective caregiving burden; (e) appraisal of the caregiving situation and confidence in caregiving; and (f) personal resources and personal resilience. Depressive distress was measured by the CES-D. Objective caregiving loads and subjective caregiving burden was measured by care tasks and levels of care and the Caregiver Reaction Assessment, respectively. Personal resilience of caregivers and confidence in caregiving was measured by the Sense of Coherence (SOC) Scale and the items developed by Teno et al (2001), respectively. Hierarchical multiple regression was conducted to determine contribution of each predisposing factor to experiencing depressive distress among caregivers following the aforementioned sequence. The scores on the CES-D ranged from 3 to 55 with a mean and standard deviation of 24.16 (11.07). A total of 73.7% of variance was explained by the final regression model. Results indicated that, except for objective caregiving loads, the other five categories of predisposing factors all contributed significantly to the variance of experiencing depressive distress among caregivers. In the final step of regression, SOC of caregivers increases explained variation in depressive symptoms by 17.3%. Conclusion: Taiwanese family caregivers of terminally ill cancer patients were at an extraordinarily high risk of experiencing depressive distress based on the high mean score of the CES-D. Development of interventions that enhance caregivers' SOC by assisting in promoting positive appraisal, finding meaning, and mobilizing resources to manage the caregiving situation is recommended. Funding Sources: National Health Research Institute. (NHRI-EX94-9406PC) [ABSTRACT FROM AUTHOR]

Background: Prognostic disclosure is a show of respect for patient autonomy. Only patients who are aware of their prognosis can participate in discussions about their medical condition and make decisions that meet their individual preferences. Despite the abundant literature on this topic, no systematic estimates of prognostic disclosure in cancer patients are available and relatively little research has focused on the impact of prognostic awareness and disclosure on cancer patients. Methods: The literature on prognostic awareness and disclosure in cancer patients was systematically reviewed and subjected to a meta-analysis. Results: The literature search retrieved 25 articles for meta-analysis. The pooled proportion of preferences for prognostic information and prognostic disclosure was calculated. Most cancer patients expressed a preference for prognostic disclosure [84.6%, 95% confidence interval (CI) 74.1%-91.4%)], but only about half were told their prognosis (49.3%, 95% CI 36.4%- 62.3%). These results indicate a gap between cancer patients’ preferences for prognostic disclosure and their actual receipt of prognosis. Cancer patients who are not told their prognosis may have several negative consequences, including inappropriate prognostic awareness, receiving futile treatment at the end of life, being unprepared for death, increased psychological and mental distress as well as social and spiritual suffering, and decreased quality of life. The discrepancy between patients’ preferred and actual prognostic disclosure is primarily due to physicians’ difficulty in revealing the prognosis; this difficulty stems from inaccurate estimates of prognosis, attitudes of beneficence and maintaining patients’ hope, lack of good communication skills, and not knowing patients’ preferences for prognostic information. Conclusions: In order to close the gap between patients’ preferences for prognostic disclosure and actual receipt of prognostic information, healthcare professionals should develop interventions to overcome the physicians’ difficulty in revealing prognosis, thus facilitating cancer patients’ awareness of prognosis and providing high quality end-of-life care.

Background/Purpose: To investigate the quality of care (QOC) for lung cancer in Taiwan, as measured by pattern of care (POC) variation. Methods: Based on core measures in the Taiwan Cancer Database (TCDB) registry, QOC for lung cancer was measured as variation in POC for 16 selected core measures for different hospital characteristics. Statistical significance in variation was evaluated by the χ2 test. Results: Among the 26 participating hospitals (one excluded as an outlier), 6624 cases of lung cancer were reported in 2004. Among the 16 core measures (6 in the diagnostic and 10 in the therapeutic domain), no significant variation in POC was noted in 12 in northern and non-northern hospitals. However, significant variation in POC was noted for most (5/6) of the core measures in the diagnostic domain for other hospital characteristics (large vs. small, medical center vs. regional hospital, public vs. private). Increasing utilization of tissue diagnosis, diagnostic computed tomography (CT), and CT or magnetic resonance imaging for staging advanced non-small cell lung cancer was noted in the four participating hospitals from 2002 to 2004. Conclusion: It is very likely that significant variation in QOC for lung cancer in Taiwan exists among different types but not locations of hospitals, at least in the diagnostic domain. The introduction of internal benchmarking (TCDB and core measures) was associated with some changes, at least in some diagnostic domains, which may lead to improvement in QOC for lung cancer in Taiwan.

Understanding the needs of cancer patients and their family is a vital step for designing cancer support program and providing need-sensitive supportive care for cancer patients and their family. Cancer is the leading cause of death for the past 24 years in Taiwan. The needs of Taiwanese cancer patients and their family along the cancer trajectory not yet fully explored. To better understand the need of Taiwanese adult cancer patients and their family along cancer trajectory, key-informant and cancer-patient-and-family focus groups were conducted. The philosophic underpinnings of this study are based on the belief that the assessment of needs for cancer care is best to be discovered through the cancer experience of the human beings with cancer and the caregiving experience of family and healthcare professionals. A purpose sample of 23 adult cancer patients, family members and cancer care professionals were recruited in Taipei city. The patient-family group included 10 patients with various cancers and having treatment experience, and two family caregivers. The key informant groups comprised one cancer patient, one family caregiver, and nine professionals, including medical oncologists, radiation oncologists, nurses, social workers, and one psychologist. Using content analysis, the main themes identified in focus groups of the qualitative study were: being treated as a human being, being able to have trust on professionals and gaining support, and keeping away from suffering, getting connected with resources, returning to community. Being as a human being was characterized as being informed, understood and accepted and having confidence. The needs to be connected with cancer care providers and cancer survivors both in clinic and in community were stressed. The results of this qualitative study have been used to develop cancer support programs and to network cancer resources and cancer care providers. Funding Sources: Funded by Department of Health, Taiwan, Republic of China [ABSTRACT FROM AUTHOR]