Branding Palliative Care Units by Avoiding the Terms "Palliative" and "Hospice": A Nationwide Study in Taiwan

By Dai, Ying-Xiu; Chen, Tzeng-Ji et al. | Inquiry, Annual 2017 | Go to article overview

Branding Palliative Care Units by Avoiding the Terms "Palliative" and "Hospice": A Nationwide Study in Taiwan


Dai, Ying-Xiu, Chen, Tzeng-Ji, Lin, Ming-Hwai, Inquiry


Abstract

The term "palliative care" has a negative connotation and may act as a barrier to early patient referrals. Rebranding has thus been proposed as a strategy to reduce the negative perceptions associated with palliative care. For example, using the term "supportive care" instead of "palliative care" in naming palliative care units has been proposed in several studies. In Taiwan, terms other than "palliative" and "hospice" are already widely used in the names of palliative care units. With this in mind, this study investigated the characteristics of palliative care unit names in order to better understand the role of naming in palliative care. Relevant data were collected from the Taiwan Academy of Hospice Palliative Medicine, the National Health Insurance Administration of the Ministry of Health and Welfare, and the open database maintained by the government of Taiwan. We found a clear phenomenon of avoiding use of the terms "palliative" and "hospice" in the naming of palliative care units, a phenomenon that reflects the stigma attached to the terms "palliative" and "hospice" in Taiwan. At the time of the study (September, 2016), there were 55 palliative care units in Taiwan. Only 20.0% (n = 11) of the palliative care unit names included the term "palliative," while 25.2% (n = 14) included the term "hospice." Religiously affiliated hospitals were less likely to use the terms "palliative" and "hospice" ([chi.sup.2] = 11.461, P = .001). There was also a lower prevalence of use of the terms "palliative" and "hospice" for naming palliative care units in private hospitals than in public hospitals ([chi.sup.2] = 4.61, P = .032). This finding highlights the strong stigma attached to the terms "palliative" and "hospice" in Taiwan. It is hypothesized that sociocultural and religious factors may partially account for this phenomenon.

Keywords

palliative care, hospice, stigma, names, Taiwan

Introduction

The World Health Organization (WHO) defines "palliative care" as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, including physical, psychosocial, and spiritual problems. (1) Most cancer patients, for example, experience multiple forms of physical and psychological distress at all stages of their illness, with cancer-related symptoms significantly impacting their daily activity and quality of life. (2) According to the WHO, palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. (1) Multiple studies have shown that integrating palliative care early in the disease trajectory improves symptom control, quality of life, patient and caregiver satisfaction, end-of-life care, costs of care, and, potentially, survival. (3-7) Despite the increased use of palliative care, however, most patients only receive the service late in the disease trajectory or not at all. 8-11 Prior research has suggested that the term "palliative care" itself might be a deterrent to early referrals and that the term "supportive care" may be more favorable for some hospital-based palliative care programs. (12-14) The term "palliative care" carries a stigma for physicians, patients, and their caregivers, who regard it as synonymous with death and dying, loss of control, hopelessness, and abandonment. "Supportive care," in contrast, has been regarded as a more favorable term. (15, 16) According to previous studies, the term "supportive care" is associated with better understanding, more favorable impressions, higher future perceived need, and earlier referrals. …

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