Jui-Hung Tsai

Background: Death preparations can benefit families both before and during bereavement. While these preparations are culturally influenced, evidence from non-Western cultures, like Eastern Asia, is limited. Aim: To explore how family caregivers prepare for a relative’s death in Taiwan. Design: A qualitative interview study analysed with reflexive thematic analysis. Setting/participants: Twenty-two primary family caregivers following a death involving specialist palliative care were interviewed. Results: An overarching theme was ‘getting everything right to have no regrets between the dead and the living’. Within this, two themes focussed upon improving the dying relative’s outcomes and the families’ subsequent bereavement: (1) ‘making the right end-of-life decisions is crucial but complex’, exploring preparations to involve (or not) the dying relative in making choices to minimise regrets. Participants often felt they understood the dying relative’s wishes so respected their preferences while maintaining family harmony through consensus-building and professional guidance. (2) ‘becoming a competent caregiver is the priority’, addressing preparations for fulfilling responsibilities, making sacrifices and developing caregiving competence to ensure the dying relative’s comfort. This would help reduce feelings of regret about not having done enough. Conclusion: Preparing for end-of-life decisions and caregiving is important for participants to reduce regret, benefiting subsequent bereavement. Of particular importance is family involvement and consensus-building in end-of-life decisions, reflecting Taiwan’s family-led culture. These findings can inform clinical practices in family-centric decision-making cultures where healthcare workers should be aware of the need to build consensus, sometimes without involving the dying person. Future research should include patients’ and healthcare professionals’ perspectives.

Background and Objective Approximately half of lung adenocarcinomas in East Asia harbor epidermal growth factor receptor (EGFR) mutations. EGFR testing followed by tissue-based next-generation sequencing (NGS), upfront tissue-based NGS, and complementary NGS approaches have emerged on the front line to guide personalized therapy. We study the cost effectiveness of exclusionary EGFR testing for Taiwanese patients newly diagnosed with advanced lung adenocarcinoma. Methods This economic evaluation was conducted from the perspective of the healthcare sector with a lifetime horizon. Simulated patients were entered into a joint model combining decision trees and partitioned survival models upon diagnosis of advanced lung adenocarcinoma. We compared exclusionary EGFR testing with upfront tissue-based NGS and complementary NGS approaches. The model inputs were derived from regional estimates (prevalence of targetable gene alterations), trials (testing accuracy, survival outcomes, and adverse events), ACT Genomics (testing costs), National Health Insurance payments, retail prices (drug costs), and hospital cohorts (utility values). All costs were made equivalent to 2023 US dollars. An annual discount rate of 3% was applied. We adopted a willingness-to-pay threshold of US$70,000 per quality-adjusted life-year. One-way deterministic and probabilistic analyses were performed. Results The incremental cost-effectiveness ratio of exclusionary EGFR testing versus upfront tissue-based NGS was US$15,521 per quality-adjusted life-year, whereas the incremental net monetary benefit was US$2530. The costs of osimertinib and pembrolizumab were the major determinants. The incremental net monetary benefit of exclusionary EGFR testing versus complementary NGS approach was US$2174, and its major determinants included the true-negative rate of EGFR testing and the prevalence rate of an EGFR mutation. Given the willingness-to-pay thresholds of US$35,000, US$70,000, and US$105,000 (1, 2, and 3 per capita gross domestic product) per quality-adjusted life-year, the probabilities that exclusionary EGFR testing would be cost effective were 79.1%, 95.6%, and 91.2%, respectively. Conclusions Our analysis suggests that exclusionary EGFR testing is a cost-effective strategy for Taiwanese patients newly diagnosed with advanced lung adenocarcinoma.

Background: Adequate death preparation positively influences families’ experience before death and during bereavement. However, how to prepare families in non-Western cultures has received scant attention. Aim: To explore family caregivers’ experiences in preparing for a relative’s death in specialist palliative care in Taiwan. Design: A qualitative study employing reflexive thematic analysis of data collected from semi-structured interviews was conducted. Setting/participants: Twenty-two family caregivers from seven hospitals participated. Results: The overarching theme was ‘getting everything right to have no regrets between the dead and the living’. We developed two themes to explain preparations for the time surrounding and after the death, including the deceased’ afterlife: (1) ‘having a good ending but not the end of the relationship’, which addresses preparations for the death itself, the funeral, the afterlife and maintaining connections and (2) ‘using religious beliefs and cultural norms to guide preparation’, which explores perceptions of a good death, including refrain from strong emotions before and after the death. Conclusion: Funeral arrangements, enhancing the deceased’s afterlife and maintaining connections to the deceased are crucial for families’ experiences which can be impacted by actions they take as they prepare for the death. A culturally appropriate death is beneficial for the dying relative which includes preparing to not show strong emotions during and after the death. These insights inform the importance of the cultural context in death preparation in Taiwan and provide perspectives for palliative care beyond Western culture, potentially benefiting Chinese populations, predominantly East Asian and Buddhist societies.

PurposeLimited efficacy has been observed when using morphine to treat neuropathic pain. Lidocaine patches reduce neuropathic pain in post-herpetic neuralgia, but their benefits for cancer-related neuropathic pain remain unclear. This study aimed to demonstrate a useful treatment for cancer-related neuropathic pain. The primary endpoint was pain intensity evaluated by the visual analog scale (VAS). The secondary endpoints were the pain relief score and the quality of analgesic treatment. MethodsWe assessed the efficacy and safety of lidocaine patches in patients experiencing neuropathic cancer pain. Terminal cancer patients with opioid treatment resistance participated in the 3-day study. ResultsThe results showed a statistically significant difference in the median VAS over three days (Kruskal-Wallis test, P<0.0001). The median VAS pain intensity from Day 1 to Day 3 was 4.0 with 95% C.I. (3.3, 5.0), 3.0 (2.5, 3.5) and 2.5 (2.0, 3.0), respectively. The difference between the median VAS pain intensities of any two days was statistically significant (Wilcoxon signed-rank test, P < 0.0001). There was no statistically significant difference in the pain relief score or the quality of analgesic treatment. ConclusionIn this study, the 5% lidocaine transdermal patch reduced the VAS pain intensity in neuropathic cancer patients with morphine resistance. The transdermal patch is generally useful and well-tolerated.