To let the general public,regardless of gender,age,career and education background,understand the core concept of hospice and palliative care,practice in their lives,and then spread to and serve as many people as possible,the hospice and palliative care team of Peking Union Medical College Hospital established the professional hospice and palliative care training platform for volunteers in 2021.This article reviews the training design,content,methods,and results of the platform.It is concluded that the platform has theory-based training design,logical and complete training content,suitable training method for volunteers,and satisfactory training results.The establishment of this hospice and palliative care training platform for volunteers has excellent feasibility.Efforts should be made to further explore the performance and long-term development strategy of the training platform.
Humans ; Hospices ; Palliative Care ; Hospice Care ; Volunteers/education*

Community-based home hospice care provided by community service centers and family physician teams aims to alleviate the suffering of terminally ill patients and help them to receive end-of-life care and pass away at home.The Puhuangyu Community Health Service Center established the home hospice care model of PUMCH-Puhuangyu Coordination at the end of 2019.The model has been practiced and improved to date.This paper introduces this model of home hospice care.
Humans ; Hospice Care ; Tertiary Care Centers ; Hospices ; Home Care Services ; Terminal Care

Objective To investigate the feasibility of home hospice care based on the practical experience in Puhuangyu community of Beijing.Methods We selected the patients assessed by hospice care team and receiving home hospice care from Puhuangyu Community Health Service Center of Beijing from January 1,2020 to December 31,2021.The clinical manifestations,hospice services received,and place of death of the patients were analyzed. Results A total of 24 patients were included in this study.They mainly suffered from malignant tumors(18 patients,75.0%),with pain as the most common symptom(12 patients,50.0%).The patients received a variety of hospice services through a combination of outpatient visits,home visits,and WeChat follow-up.The service time of each patient was(2.8±1.7) h each week on average and 57.9%(11/19) of the patients passed away at home. Conclusions The home hospice care in Puhuangyu community has a stable source of patients.The members of this hospice team can provide a variety of home hospice services.With this model,the wish to pass away at home can be achievable for most patients.Therefore,this model of community-based home hospice care is feasible.
Humans ; Hospice Care ; Hospices ; Beijing ; Home Care Services

Hospice Care ; Hospices ; Humans ; Palliative Care ; Renal Dialysis

Objective To share the outpatient clinic practice of hospice and palliative care at the Department of Geriatrics,Peking Union Medical College Hospital.Methods We conducted a retrospective analysis on the consecutive clinic data of doctor N in Geriatric Outpatient Clinic,Peking Union Medical College Hospital from January 1,2016 to December 31,2019.The patients aged 85 years and older,as well as those with end stage malignant tumor,non-tumor dysfunction due to chronic diseases or primary diseases without effective treatment were defined as patients with palliative care need.The basic information,symptoms,consultation purposes and treatments of these patients were collected.Results Among the 2502 visits during the study period,1388 patients with palliative care needs were admitted and recorded,with an average age of(69.7±13.5)years(8-105 years),among which 73.3% were patients over 60 years old and 712(51.3%)were males.Among these patients,63.4% visited specifically to seek for palliative care service and 87.2% of the visits were due to distress caused by advanced malignant tumors.Of the 221 patients with non-tumor diseases,frailty and neurodegenerative diseases were the leading life-threating cause.Of the 5483 symptoms recorded,pain(21.2%),anorexia(13.1%),fatigue(11.6%),constipation(6.9%),insomnia(4.6%),and abdominal distension(4.6%)were the six common symptoms.In the 2502 visits,26.2% of the patients had mutiple visits,and 50.3% of the patients with multiple visits had more than three visits;38.6% of patients visited the clinic themselves,and 65.7% of visits were attended by two or more family members(including the patients).The average duration of visit was(19.6±8.5)min(2-85 min),and 13.5%,53.0%,25.6% and 7.9% of the patients completed the consultation within 10,11-20,21-30 and over 30 min,respectively.Conclusion There is strong demand of palliative care in the outpatient clinic of Department of Geriatrics in Peking Union Medical College Hospital and it is feasible to provide palliative care service for patients with serious diseases in geriatric outpatient clinics.
Aged ; Aged, 80 and over ; Ambulatory Care Facilities ; Female ; Hospice Care ; Hospices ; Humans ; Male ; Middle Aged ; Palliative Care ; Retrospective Studies

Background and Objective: Palliative care is a human right. In the local setting, only a few data have been published regarding its practice among healthcare workers. This study aimed to determine the gaps and potential barriers in palliative care services among resident physicians. Methodology: A cross-sectional study design using a 27-item interview-based questionnaire was conducted from July to September 2019 among resident trainees in seven departments of four hospitals in Manila, Philippines. The data gathered were tallied using Microsoft Excel and analyzed using STATA Statistical Software with p-value of 0.05 as statistically significant. Results: A total of 200 physicians participated in the study. Majority of the respondents referred patients to palliative care services, primarily for symptom control and home care upon the diagnosis of a terminal illness. Sixty percent of respondents correctly identified patients eligible for hospice care. The 3 services rated as most important in palliative care were pain control, symptom control and psychological support. Most of the respondents perceived that palliative care is underutilized, and yet they felt that attending doctors know when referral to such is appropriate. The discrepancy is due to their lack of knowledge on the nature of its scope of care and eligibility criteria. The common barriers for referral to palliative care were “no time to refer secondary to rapid demise of the patient”, “difficulty in accurately predicting death”, and “lack of time to discuss issues of dying and hospice care”. These presumed barriers contradicted the respondents’ perceived practices in advance care planning, particularly on confirming the goals of treatment with the patient and family. Conclusion The prevailing illiteracy on palliative care that poorly translates to actualization is alarming as it deprives many patients of their right to a dignified and quality of life given their limited days. The inexcusable lack of awareness must be the impetus to a massive knowledge drive to impact clinical practice.
Hospices ; Physicians

BACKGROUND: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. METHODS: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. RESULTS: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). CONCLUSION: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.
Academies and Institutes ; Fee-for-Service Plans ; Fees and Charges ; Gwangju ; Hospices ; Hospitals, General ; Humans ; Insurance ; Palliative Care ; Reward

Hospice and palliative care can help terminal patients and their family members to face the natural end of life more comfortably, by providing them with an environment to address psychosocial and spiritual problems, as well as physical symptoms. However, most patients and their caregivers have the misconception that hospice care means the withdrawal of all treatments. Many physicians also consider hospice care to be a form of terminal care after all treatments are finished. Laws regulating the withdrawal of life-prolonging treatment came into effect in Korea in 2018, and these regulations also apply to most terminal stages of benign diseases. The withdrawal of futile life-prolonging treatment is quite different from euthanasia or negligence. At the last stage of disease, treatment aimed at alleviating various symptoms can make critically ill patients more comfortable and thereby help them to die with dignity. Patients with a terminal illness should receive hospice and palliative care, instead of futile life-prolonging treatment. Therefore, education and training programs to promote a proper understanding of hospice and palliative care should be considered mandatory.
Caregivers ; Critical Illness ; Education ; Euthanasia ; Hospice Care ; Hospices ; Humans ; Jurisprudence ; Korea ; Malpractice ; Palliative Care ; Social Control, Formal ; Terminal Care ; Withholding Treatment

PURPOSE: The Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life was enacted in 2016 and has taken effect since 2018 February. The content of this act was based on Physician Orders for Life-Sustaining Treatment (POLST) in the United States and we modified it for terminal cancer patients registering hospice. The object of this study is to investigate preference and implementation rate for modified Korean POLST (MMK-POLST) items in hospice ward.METHODS: From February 1, 2017 to April 30, 2019, medical records regarding MMK-POLST were retrospectively analyzed for all patients hospitalized in the hospice ward of Gyeongsang National University Hospital.RESULTS: Of the eligible 387 total cohorts, 295 patients filled out MK-POLST. MK-POLST has been completed in 133 cases (44.1%) by the patient themselves, 84 cases (28.5%) by the spouse, and 75 cases (25.4%) by their children, respectively. While only 13 (4.4%) out of 295 MK-POLST completed patients refused the parenteral nutrition and 5 patients (1.7%) for palliative sedation, the absolute majority of 288 (97.6%) patients did not want cardiopulmonary resuscitation (CPR) and ventilators and 226 people (76.9%) for pressor medications. Kappa values for the matched strength of MK-POLST implementation were poor for all items except CPR, ventilators and palliative sedation.CONCLUSION: Hospice patients refused to conduct cardiopulmonary resuscitation, ventilators and pressor agents. In contrast, antibiotics, parenteral nutrition and palliative sedation were favored in the majority of patients.
Advance Care Planning ; Advance Directives ; Anti-Bacterial Agents ; Cardiopulmonary Resuscitation ; Child ; Cohort Studies ; Hospice Care ; Hospices ; Humans ; Medical Records ; Palliative Care ; Parenteral Nutrition ; Retrospective Studies ; Spouses ; Terminal Care ; United States ; Ventilators, Mechanical

PURPOSE: Hospice volunteers are serving an invisible yet pivotal role in the hospice and palliative care team. This study investigated how effectively a continuing education program could enhance hospice volunteers' competency.METHODS: A total of 20 hours (four hours per week) of training was provided to 30 hospice volunteers who participated in the continuing education for hospice volunteers. Efficiency of the education was analyzed with an exploratory mixed-methods design. For quantitative analysis, the volunteers were asked, before and after the training, about their attitudes towards hospice care, what makes a meaningful life, self-efficacy and satisfaction with their volunteer service. Descriptive statistics, paired t-tests, and Wilcoxon signed-rank test were performed using SPSS Window 20.0. For qualitative research, participants were placed in three groups for a focus group interview, and data were analyzed by content analysis.RESULTS: A quantitative study result shows that this training can significantly affect hospice volunteers' attitudes and improve their self-efficacy. A qualitative study result shows that participants wanted to receive continuous education from the physical/psychosocial/spiritual aspects to better serve end-of-life patients and their family members even though they have to spare significant time for the volunteer service. They wanted to know how to take good care of patients without getting themselves injured and how to provide spiritual care.CONCLUSION: The continuing education program reflecting volunteers' requests is strongly needed to improve their competency. An effective continuing education requires continuous training and support in areas where hospice volunteers are interested in. A good alternative is to combine web-based and hands-on training, thereby allowing hospice volunteers freely take training that suits their interest.
Education ; Education, Continuing ; Focus Groups ; Hospice Care ; Hospices ; Hospital Volunteers ; Humans ; Palliative Care ; Qualitative Research ; Volunteers