{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T12:40:48Z","timestamp":1792327248202,"version":"4.4.0"},"reference-count":27,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Ministry of Health and Welfare"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Identifying end-of-life (EOL) dialysis patients who may benefit from palliative care remains challenging in Asian healthcare settings where relational autonomy predominates over individual decision-making. We conducted a national consensus study in Taiwan during 2015-2016 to develop validated EOL indicators for dialysis patients, with findings subsequently validated through a decade of clinical experience including the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a three-phase study: (1) systematic literature review; (2) two-round expert focus groups using the RAND\/UCLA Appropriateness Method with 15 multidisciplinary experts; and (3) national survey of nephrologists from 624 dialysis facilities. Nine indicators were evaluated using 9-point Likert scales. Exploratory and confirmatory factor analyses identified latent constructs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 624 facilities, 337 responded (54.0%), yielding 254 nephrologists with complete responses (22.6% of registered specialists). Two indicators achieved high consensus (\u226590%) for both hospice\/dying care and advance care planning: prolonged mechanical ventilation (PMV) with dialysis in unconscious state, and PMV with multi-organ failure. Factor analysis identified three EOL patient subgroups: ventilator-dependent, critically ill, and functionally dependent, with acceptable CFA model fit (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      = 27.6, df = 19,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.091; RMSEA = 0.042; CFI = 0.99). ACP ratings yielded a two-factor structure with adequate fit (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      = 35.5, df = 20,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.018; RMSEA = 0.055).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dialysis patients with PMV combined with unconsciousness or multi-organ failure represent the highest-consensus EOL indicators in Taiwan. These validated findings offer actionable guidance for hospice and end-of-life care referral within healthcare systems characterized by relational autonomy and collective family-patient-clinician deliberation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091261496806","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:51:25Z","timestamp":1792086685000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Validation of End-Of-Life Indicators for Dialysis Patients: A National Consensus Study in Taiwan"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0689-8339","authenticated-orcid":false,"given":"Hung-Bin","family":"Tsai","sequence":"first","affiliation":[{"name":"National Taiwan University Hospital"},{"name":"National Taiwan University Hospital"},{"name":"National Taiwan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2892-7986","authenticated-orcid":false,"given":"Chia-Ter","family":"Chao","sequence":"additional","affiliation":[{"name":"National Taiwan University Hospital"},{"name":"National Taiwan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Yi","family":"Cheng","sequence":"additional","affiliation":[{"name":"National Taiwan University"},{"name":"National Taiwan University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan-Yu","family":"Hung","sequence":"additional","affiliation":[{"name":"National Taiwan University Hospital"},{"name":"National Taiwan University"},{"name":"National Taiwan University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1235-1943","authenticated-orcid":false,"given":"Feng-Jung","family":"Yang","sequence":"additional","affiliation":[{"name":"National Taiwan University Hospital"},{"name":"National Taiwan University"},{"name":"National Taiwan University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray-E.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Healthcare Management, College of Medical Technology and Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan"},{"name":"National Taipei University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"Taiwan Renal Registry Annual Report 2023","author":"Taiwan Society of N","year":"2024","unstructured":"Taiwan Society of N. 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