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Cited by 11Palliative Care and End-of-Life IssuesFamily and Patient Care in Intensive Care UnitsPalliative and Oncologic Care

Impact of patient-centred and family-centred care meetings on intensive care and resource utilisation in patients with terminal illness: a single-centre retrospective observational study in Taiwan

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Hsu, Nin-Chieh, Huang, Chun-Che, Chen, Wei-Chun, Yu, Chong-Jen·2019·BMJ Open
DOI 10.1136/bmjopen-2018-021561PMC PMC6368162
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Abstract

Objective: Shared decision making is essential for patients and their families when facing serious and life-threatening diseases. This study aimed to evaluate the impact of patient-centred and family-centred care meetings (PFCCM) on intensive measures and resource utilisation during end-of-life (EOL) hospitalisation among terminally ill patients. Design and setting: A retrospective cross-sectional study using electronic medical records was conducted in a tertiary referral medical centre in Taiwan. Participants: We identified 6843 deceased patients with terminal illness who either received or did not receive PFCCM during EOL hospitalisation between January 2013 and December 2015. Primary and secondary outcome measures: Patients who were transferred to the intensive care unit (ICU). Those who underwent invasive or non-invasive mechanical ventilation, tracheostomy, haemodialysis and surgical intervention during the final hospitalisation were determined by the use of intensive care measures; secondary measures were individual total and daily medical expenditures. A generalised estimating equation (GEE) model was used to compare the differences between the two groups. OR and beta coefficients (β) with 95% CI were estimated. Results: This study identified 459 patients (6.7%) who received PFCCM during EOL hospitalisation. Multivariate analyses showed that patients who received PFCCM were less likely to have ICU admissions (OR 0.44, 95% CI 0.34 to 0.57), undergo surgical interventions (OR 0.74, 95% CI 0.58 to 0.95) and invasive mechanical ventilation (OR 0.50, 95% CI 0.38 to 0.66) during the final hospitalisation, after adjusting for patient demographics, clinical conditions and year of admission. Additionally, a significant decrease in daily medical expenditures was observed in PFCCM patients (β −0.18, 95% CI −0.25 to −0.12) than in non-PFCCM patients. Conclusions: Patient–physician discussion through PFCCM is associated with less intensive care utilisation and daily medical expenditure during EOL hospitalisation in terminally ill patients.

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  • Communication supported by strategies such as video decision aids may be associated with improved family satisfaction, according to recent studies.

    “Furthermore, according to recent studies, communication supported by other strategies such as video decision aids may be associated with improved family satisfaction. 67,75,78”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [78]

    The Methods (Variables) describe patient- and family-centred care meetings, while the Conclusions report associations with intensive-care use and medical expenditure. Neither section reports family satisfaction or the use of video decision aids; searches for those terms found no supporting passage in our copy. (LLM, conf=0.75)

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Cited by

Sorted by citations

Authors
Hsu, N.-C., Huang, C.-C., Chen, W.-C., & Yu, C.-J.
Affiliations
  • National Taiwan University Hospital (TW)
  • Taichung Veterans General Hospital (TW)
Corresponding author
Hsu, Nin-Chieh
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2019-02
Volume
9
Issue
2
Pages
e021561
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2018-021561
PMC
PMC6368162
OpenAlex
W2913123933
Cited by
11
References
1
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2022: 2 · 2021: 4 · 2020: 1
FWCI
1.61
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Taiwan University Hospital
  • National Taiwan University
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
shared decision-making, end-of-life care, terminal illness, mechanical ventilation, intensive care unit admission, health care costs, tracheostomy, hemodialysis, surgical treatment, patient-physician communication
MeSH terms
Decision Making, Shared, Adolescent, Adult, Aged, Critical Care, Cross-Sectional Studies, Health Expenditures, Female, Health Resources, Hospitalization, Humans, Intensive Care Units, Male, Middle Aged, Physician-Patient Relations, Regression Analysis, Retrospective Studies, Taiwan, Terminal Care, Multivariate Analysis, Patient-Centered Care, Young Adult

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