The Trend of Receiving Palliative Care in Patients With Prolonged Mechanical Ventilation in Taiwan

Abstract

Background:

According to the World Health Organization, palliative care (PC) is an indispensable part of continuing care at the end of life that emphasizes the importance. Patients can have dignity and quality at the end of life, not extend the dying process. Patients on prolonged mechanical ventilation (PMV) not only have a low quality of life, but also create a burden on the health insurance system. Therefore, it is important to understand the current status of these patients receiving PC and make improvements accordingly.

Methods:

We used a healthcare database consisting of a 100 million person sampling file from the Ministry of Health and Welfare in Taiwan. We screened for PMV patients who were >17 years of age between 2011 and 2013. The target patients were intubated with ventilator support for >21 days, including invasive ventilators, non-invasive ventilators, and patients from 2010 were excluded. Data analysis was performed using a simple random sample with SPSS 20. One-way ANOVA was used to analyze the numbers, ratios, and disease types among the PMV patients who received PC during the period 2011-2013. A p <0.05 was considered statistically significant.

Results:

Among the 79,399, 61,232 and 63,192 patients on PMV, there were 226 (0.28%), 133 (0.22%) and 479 (0.76%) who received PC in 2011, 2012, and 2013, respectively (P<0.05; Fig. 1). The proportions of the PMV patients who received PC were low, but the number of patients was increasing. Among the PMV patients who received PC in 2011, 2012 and 2013, there were 11 (4.9%), 5 (3.8%) and 22 (4.6%) patients diagnosed with sepsis (P=0.47);150 (66.4%), 88 (66.1%) and 325 (67.8%) patients diagnosed with malignant tumor (P=0.68); 56 (24.7%), 33 (24.8%) and 110 (23.1%) patients diagnosed with chronic illness (P=0.45); 9 (4%), 7 (5.3%) and 22 (4.5%) patients diagnosed with late effects of motor vehicle accident (P=0.76) (Fig. 1).

Conclusions:

This study showed there to be an increasing proportion of patients on PMV who received PC. The trend in providing PC can be attributed to promotions involving ineffective medical treatment and PC for critically ill and PMV patients since 2011 in Taiwan. The promotions not only increased the number of patients with malignancies, but also different groups of disease types. This indicates a need to promote PC for patients receiving PMV to improve the quality of life, as well as reduce the burden on the health insurance system. We believe that increasing the use of PC will reduce suffering in end-stage PMV patients.

Fig. 1. PMV disease types receiving palliative care.