A Comparison of impact of Advance Care Planning between Palliative Patients with advance cancer and advance stage of chronic diseases at Buayai Hospital Nakhonratchasima Province

Abstract

Background: Buayai Hospital’s Palliative care clinic found that patients in the advance stage of chronic disease are often referred for consultation on palliative care during the final period of life. Which differs from advance cancer patients who are referred for consultation once diagnose early on. As a result, advance stage of chronic disease patients received palliative care and advance care planning (ACP) is delayed. In additional, the progression of the disease in the terminal stages is different, therefor a study was conducted to compare the impact of ACP.
Objective: To compare the impact of ACP on 1. Non beneficial treatment 2. Place of death and 3. Hospital length of stay within 30 days before death between advance cancer and advance stage of chronic disease patients.
Method: A retrospective analytic study was conducted base on the medical records of patients who received the ACP process at Buayai Hospital. The sample included patients in two groups: 111 advance cancer patients and 75 advance stage of chronic disease patients who died between October 1^st, 2022 and September 30^th, 2023. Data were collected by using a structured form and analyzed with descriptive and inferential statistics analysis (Chi square and a t-test).
Results: Out of 186 patients, 147 cases were qualified (92 in the advance cancer group and 55 in the advance stage of chronic disease group). Patients in the advance stage of chronic disease group were significantly older (76 ± 11.9 years versus 69 ± 13.6 years; p-value=0.001), The proportion of performance status differed significantly between the two groups (p-value < 0.001). ACP was shown to influence non-beneficial treatment, place of death, and hospital length of stay within 30 days before death; however, these differences were not statistically significant. The advance cancer group and the advance stage of chronic disease group received Endotracheal tube intubation 1.1%, 7.3% (p-value = 0.169), cardiopulmonary resuscitation 1.1%, 5.5% (p-value = 0.115) the place of death was mostly at home (92.4, 81.8 p- value = 0.057). The mean of length of stay in the 30 days before death was 4.0 ± 5.0, 5.0 ± 7.5 days (p- value = 0.325).
Conclusion: The impact of ACP on non-beneficial treatment, place of death, and hospital length of stay within 30 days before death showed no statistical significance. Both groups received end of life care in accordance with their recorded intentions.