Emulation of a Target Trial to Evaluate the Causal Effect of Palliative Care Consultation on the Survival Time of Patients with Hepatocellular Carcinoma

Palliative care has the potential to improve the quality of life of patients with incurable diseases or cancer, such as hepatocellular carcinoma (HCC). A common misconception of palliative care with respect to the patient’s survival remains a significant barrier to the discipline. This study aimed to provide causal evidence for the effect of palliative care consultation on the survival time after diagnosis among HCC patients. An emulation of a target trial was conducted on a retrospective cohort of HCC patients from January 2017 to August 2019. The primary endpoint was the restricted mean survival time (RMST) at 12 months after HCC diagnosis. We used the clone–censor–weight approach to account for potential immortal time bias. In this study, 86 patients with palliative care consultation and 71 patients without palliative care consultation were included. The adjusted RMST difference was −29.7 (95% confidence interval (CI): −81.7, 22.3; p-value = 0.263) days in favor of no palliative care consultation. However, palliative care consultation was associated with an increase in the prescription of symptom control medications, as well as a reduction in life-sustaining interventions and healthcare costs. Our findings suggest that palliative care consultation was associated with neither additional survival benefit nor harm in HCC patients. The misconception that it significantly accelerates the dying process should be disregarded

Emulation of a Target Trial to Evaluate the Causal Effect of Palliative Care Consultation on the Survival Time of Patients with Hepatocellular Carcinoma

Palliative care has the potential to improve the quality of life of patients with incurable diseases or cancer, such as hepatocellular carcinoma (HCC). A common misconception of palliative care with respect to the patient’s survival remains a significant barrier to the discipline. This study aimed to provide causal evidence for the effect of palliative care consultation on the survival time after diagnosis among HCC patients. An emulation of a target trial was conducted on a retrospective cohort of HCC patients from January 2017 to August 2019. The primary endpoint was the restricted mean survival time (RMST) at 12 months after HCC diagnosis. We used the clone–censor–weight approach to account for potential immortal time bias. In this study, 86 patients with palliative care consultation and 71 patients without palliative care consultation were included. The adjusted RMST difference was −29.7 (95% confidence interval (CI): −81.7, 22.3; p-value = 0.263) days in favor of no palliative care consultation. However, palliative care consultation was associated with an increase in the prescription of symptom control medications, as well as a reduction in life-sustaining interventions and healthcare costs. Our findings suggest that palliative care consultation was associated with neither additional survival benefit nor harm in HCC patients. The misconception that it significantly accelerates the dying process should be disregarded

Is the Association between Herbal Use and Blood-Pressure Control Mediated by Medication Adherence? A Cross-Sectional Study in Primary Care

Herbs have been used worldwide for many health conditions as an alternative treatment, including hypertension. Their use might affect the use of conventional medications, as well as blood-pressure control. This study aims to determine whether the potential associations between herb use and high blood pressure in hypertensive patients was mediated by medication adherence. A cross-sectional study was conducted using questionnaires and available medical databases at a primary care clinic of a tertiary hospital in Chiang Mai, Thailand. The data were collected from 450 patients with essential hypertension. Drug adherence was assessed by the Morisky Green Levine Medication Adherence Scale. The history of herbs used in the past three months was obtained. The goal of controlled blood pressure was defined in accordance with the Thai guidelines on the treatment of hypertension. Of the total 450 patients, 42% had high adherence. Nearly 18% reported herb use in the past three months. High medication adherence was strongly associated with blood-pressure control when adjusted for age, gender, education, the presence of comorbidities, and herb use (aOR 26.73; 95% CI 8.58–83.23; p < 0.001). The association between herb use and blood-pressure control did not achieve statistical significance (p = 0.143). However, the adjusted odds ratio of the association between herb use and blood-pressure control was diluted from 0.67 to 0.83 when adding the factor of medication adherence to the model. In conclusion, herb use was associated with poor medication adherence, which was in turn associated with poor blood-pressure control. Assessing this information contributes to appropriate exploration and counseling