Comparison of End-of-life Hospice Care and Acute Ward Care in Terminal Elderly Patients with Cervical Cancer in Taiwan: Analysis of the National Health Insurance Claims Dataset

子宮頸癌末期高齡病患接受安寧病房住院照護與急性病房住院照護之比較性研究－台灣健保資料庫分析

蕭雅倫(Ya-Luan Hsiao) ； 林明慧(Ming-Hwai Lin) ； 黃怡璇(I-Hsuan Hwang) ； 張曉婷(Hsiao-Ting Chang) ； 黃信彰(Shinn-Jang Hwang)

《安寧療護雜誌》 18卷1期 (2013/03) Pp. 24-38

https://doi.org/10.6537/TJHPC.2013.18(1).3

摘要

子宮頸癌是台灣女性最好發的癌症之一，在2011年的女性十大癌症死因名列第七位。台灣全民健保自2000年起針對末期癌症病患給付安寧療護，持續提供全人、全家、全程、全隊高品質的照護。研究目的：旨在統整比較分析台灣2001年至2004年健保資料庫在院過世之子宮頸癌末期病人接受安寧住院照護或急性一般病房住院照護資料。材料與方法：收集資料包括總住院天數、藥物使用、侵入性檢查的比例、總住院費用、醫院等級等。結果：共分析了294位生命末期病患，其中107（36.3%）位曾接受過安寧住院照顧，而187位（63.6%）接受急性一般病房照顧。與接受急性病一般房照顧病患相比，接受安寧病房照顧病患平均總住院天數及平均醫療費用都比較少，也僅有少數者接受侵入性或積極性介入的治療。在藥物方面，77.6%安寧病房的病患都有使用嗎啡，但在急性一般病房僅佔38.0%。結論：對子宮頸癌末期病人而言，安寧緩和照顧可改善病人的生活品質，減少侵入性及積極性介入的治療，同時可降低醫療費用值得推廣。

關鍵字

急性照護 ； 末期療護 ； 子宮頸癌 ； 安寧療護 ； 全民健保

並列摘要

Background: Cervical cancer is one of the most common malignancies in Taiwanese females, and is the seventh cause of cancer death. Few researches have been done to evaluate end-of-life care in elderly advanced cervical cancer patients. Objective: To compare end-of-life hospice care with acute ward care for elderly advanced cervical cancer inpatients in Taiwan from 2001 to 2004. Patients and Methods: Data was collected from deceased cervical cancer patients ＞ 65 years old during hospital admission from 2001 through 2004 by analyzing the Taiwanese National Health Insurance Claims Database. Results: A total of 294 deceased cervical cancer inpatients were enrolled, of whom 107(36.3%) received end-of-life hospice care and 187(63.6%) received acute ward care. The patients' age did not differ significantly between the two groups. The hospice care group had a significantly shorter mean length of hospital stay and lower mean total medical expenditure compared to the acute ward care group. There were considerably more patients in hospice care group who received natural opium alkaloids (77.6%) when compared to the acute ward group where only 38 percent of patients received this medication. (p＜0.001) Invasive procedures such as nasogastric tube insertion, urinary catheterization, hemodialysis and respiratory ventilator care were all significantly less in the hospice care group than in the acute ward care group. No aggressive procedures such as endotracheal tube insertions or cardiopulmonary resuscitations were performed on hospice care patients. Conclusions: Terminal elderly cervical cancer inpatients who received hospice care had less invasive or aggressive medical intervention, shorter length of stay, and less medical expenditure than those that received acute ward care during their end-of-life hospitalization.

並列關鍵字

acute ward care ； end-of-life care ； cervical cancer ； hospice care ； National Health Insurance