THE ACCEPTANCE FACTORS THAT AFFECT THE CONCEPT OF HPC IN THE PMV PATIENTS' MAJOR CAREGIVERS.

Background: In 1990, The National Institute of Health of Taiwan set up the Step-down care model for the prolonged mechanical ventilation (PMV) patients by four stages of care, Intensive Care unit for 21 days, Respiratory Care Center for 4 2 days and then the Respiratory Care Ward (institute care) or Home Care. Due to care quality improved, the number of patients were accumulated and the cost expenditure increased. The Government want to reduce the cost, so began to promote the concept of hospice palliative care (HPC) for these unconsciousness PMV patients since 2013. The purpose of this study was to determine the acceptance factors that affect the concept of HPC in the PMV patients' major caregivers in Taiwan. Method: The survey method and quota sampling by using a structured questionnaire to collect the information. After developing the questionnaire, the content was rated by seven experts, resulting in a mean content validity index (CVI) of 0.96. The data for this study were collected from four care stages by using a predesigned questionnaire, and 601 of the 687 valid questionnaires were returned. (The valid response rate was 87.5%). The collected data were analyzed using a descriptive statistics test, Fisher's exact test and multiple regression models with generalized estimating equations. This study was approved by the Institutional Review Board of the study organizations. Results: In terms of the basic characteristics of major caregivers, there are 49.25% male and 50.75% female, mostly families identity mainly adult children (54.74%) and spouse (18.47%). The key element of acceptance factors in the PMV patients' major caregivers that affect the concept of HPC, after controlling for patient characteristics, include the care stage of PMV patient used, daily ventilator used time, sex and identity of caregiver, ever heard the HPC from medical staff introduction during hospitalization, and the cognition toward the HPC. Conclusions: This study not to show positive relationship to the cognitive and acceptance of HPC. Facing the correlated problems of HPC, the frank attitude and communication among the patients and their family members might help the appropriate decision-making and afford the good HPC. This study can provide the government a reference when promoting the HPC. Sponsored Research - The study was supported by Taiwan Department of Health Clinical Trial and Research Cent of Excellence (DOH102-NH-9009). The authors have disclosed no conflicts of interest. [ABSTRACT FROM AUTHOR]