Academic publications are important for developing a medical specialty or discipline. Peer-reviewed literature provides an evidence-based support for clinical practice and the knowledge base for quality clinical care.1,2 Exploration of the bibliographic databases can not only examine the publication progression of a related medical specialty or discipline but also the publication patterns.3
Hospice palliative care entails multidisciplinary medical approaches aiming at relief of pain and distressing symptoms by identification, assessment, and treatment of pain, physical, psychosocial, and spiritual problems to support the best possible quality of life for patients with serious life-threatening illness, and their families.2,4 The multidisciplinary approaches of hospice palliative care provided across different medical and nonmedical professions have built distinct and complex knowledge on this topic and led to various practices around the world.3
In Taiwan, hospice palliative medicine is a young medical discipline. From years of effort in the hospice palliative movement, there are increasing numbers of hospice palliative beds in hospitals,5 and increasing utilization of hospital hospice bed and home hospice care in Taiwan.6 Many professionals, including clinical hospice palliative care providers and researchers in schools, have published their clinical practice and research results; however, there is no study exploring the patterns and characteristics of these published articles in Taiwan and in other countries.
The Web of Science (WoS) is a research database officially inaugurated in 2004 by the Thomson Scientific and Health Care Corporation. The WoS database contains not only the affiliations of all authors, but also provides the citation numbers of published articles. The WoS provides access to the Thomson Reuter's multidisciplinary databases of bibliographic information such as the Science Citation Index Expanded (SCI-E), the Social Sciences Citation Index (SSCI), the Arts and Humanities Citation Index, and the Journal Citation Report (JCR).7–9 The WoS is a powerful web interface providing access to the citation databases. The aim of this study was to analyze the hospice palliative care research publications worldwide from 1993 to 2013 by searching the WoS database.
The WoS database was accessed through the Taipei Veterans General Hospital Library website on December 1, 2014. In the first stage, publications in the SCI-E and SSCI with titles containing “hospice”, “palliative care”, “end of life care”, or “terminal care” were identified. Then, we refined document types limited to articles, letters, reviews, proceedings papers, editorial materials, and notes. Thereafter, we obtained the numbers of publications from different countries/areas worldwide by years, institutes that published these documents, WoS subject categories, and journals that published these documents. In the second stage, we refined the countries to the top publishing countries in Asia, including Japan, Taiwan, South Korea, China, and India.
Results from the first and second stages were expressed by descriptive analyses. Compound annual growth rates (CAGRs) were calculated both worldwide and in Taiwan using the formula: [(article numbers in 2013/article numbers in 1993)1/number of years] – 1.
This study was exempted from review by the Institutional Review Board because we obtained its data from the public open domain of the Taipei Veterans General Hospital Library website.
Searching by document types from the WoS database including articles, letters, reviews, proceedings papers, editorial materials, and notes published in SCI-E and SSCI journals, we found a total of 27,788 published documents with topics of hospice or palliative care, or end-of-life care or terminal care, worldwide during the time frame 1993–2013. The top 10 most prolific countries/areas publishing documents were the United States (11,419 documents, 41.09%), England (3620 documents, 13.03%), Canada (2428 documents, 8.74%), Germany (1598 documents, 5.75%), Australia (1580 documents, 5.69%), the Netherlands (1119 documents, 4.03%), Italy (1038 documents, 3.74%), France (998 documents, 3.59%), Spain (795 documents, 2.86%), and Sweden (750 documents, 2.70%). Table 1 lists the 10 most prolific countries worldwide from 1993 to 2013. For document types, articles were the most common publication type (22,167 articles, 79.77%), followed by reviews (2730 review articles, 9.82%), editorial materials (1859 papers, 6.69%), proceeding paper (1172 papers, 4.22%), and letters (993 letters, 3.57%). During 1993 to 2013, Taiwan published 310 documents (1.12%) and ranked 16th worldwide. In Asia, the top five countries publishing documents on hospice palliative care were Japan (594 documents, 2.14%), Taiwan (310 documents, 1.12%), China (306 documents, 1.10%), South Korea (282 documents, 1.02%), and India (165 documents, 0.59%) (Table 2). For published document types from Taiwan, articles were the most common publication type (291 articles, 93.87%), followed by reviews (12 review articles, 3.87%), and proceeding papers (6 papers, 1.94%).
There was an increasing trend in annual total document publication from 1993 to 2013 (Fig. 1), and the CAGR was 12.90% worldwide. For Taiwan, as there were no documents published during 1993 to 1995 and 1997 to 1998, we calculated the CAGR from 1999 to 2013. There was an increasing trend of document publication from 1999 to 2013, with a CAGR of 19.40% in Taiwan, whereas during the same period, the CAGR for worldwide hospice palliative care-related publications was 10.70%. During 1993 to 1999, 2000 to 2006, and 2007 to 2013, the worldwide article publication CAGRs were 15.82%, 7.60%, and 8.62%, respectively. For Taiwan, the publication CAGRs during 2000 to 2006 and 2007 to 2013, were 15.06% and 17.92%, respectively. As for other top publishing countries in Asia, we also found increasing trends of publication for Japan, China, and South Korea (Fig. 2).
According to WoS subject categories, 27,788 documents were published in 232 categories. Among them, 7117 documents (25.61%) were published in the category of Health Care Sciences and Services, followed by the categories of Medicine, General and Internal (5882 documents, 21.17%), Oncology (4052 documents, 14.58%), Public Environmental Occupational Health (3214 documents, 11.57%), Nursing (2477documents, 8.91%), Clinical Neurology (2143documents, 7.71%), Health Policy Services (1612documents, 5.80%), the Critical Care Medicine (1272documents, 4.58%), Geriatrics and Gerontology (1040 documents, 3.74%), and Social Sciences Biomedical (1.017 documents, 3.66%) (Table 3).
The top 10 journals publishing hospice palliative care-related documents were the Journal of Pain and Symptom Management (1324 documents, 4.77%), Palliative Medicine (1300 documents, 4.68%), Journal of Palliative Medicine (1259 documents, 4.53%), Supportive Care in Cancer (602 documents, 2.17%), Journal of Palliative Care (552 documents, 1.99%), American Journal of Hospice Palliative Medicine (427 documents, 1.54%), Critical Care Medicine (418 documents, 1.50%), Journal of Clinical Oncology (332 documents, 1.20%), Journal of the American Geriatrics Society (327 documents, 1.18%), and the British Medical Journal (245 documents, 0.88%) (Table 4). The top journals publishing hospice palliative care-related documents submitted from Taiwan were the Journal of Pain and Symptom Management (22 documents, 7.10%), Supportive Care in Cancer (20 documents, 6.45%), Cancer Nursing (16 documents, 5.16%), Journal of the Formosan Medical Association (13 documents, 4.19%), and Journal of Palliative Medicine (12 documents, 3.87%).
The top 10 institutions publishing hospice palliative care-related documents worldwide were Harvard University (574 documents, 2.07%), University of Toronto (513 documents, 1.85%), University of Washington (505 documents, 1.82%), University of California San Francisco (432 documents, 1.56%), King's College London (376 documents, 1.35%), Duke University (357 documents, 1.29%), University of Pittsburgh (338 documents, 1.22%), University of Alberta (314 documents, 1.13%), University of Pennsylvania (312 documents, 1.12%), and Yale University (268 documents, 0.96%) (Table 5). In Taiwan, the top five institutions publishing hospice palliative care-related documents were National Taiwan University (84 documents, 27.10%), National Yang Ming University (71 documents, 22.90%), Chang Gung University (54 documents, 17.42%), National Taiwan University Hospital (46 documents, 14.84%), and Taipei Veterans General Hospital (34 documents, 10.97%) (Table 6).
From 1993 to 2013, the United States was the most prolific country followed by England in terms of publishing hospice palliative care-related documents. The majority of documents were published in the Health Care Sciences and Services and General and Internal Medicine categories. There were increasing trends of hospice palliative care-related document publications worldwide, with a CAGR of 12.90%. In Taiwan, there was also an increasing trend of article publication from 1999 to 2013, with a CAGR of 19.40%, whereas for the same time frame, the worldwide CAGR was 10.70%. The majority of these documents were published by universities or hospitals affiliated to universities.
Academic publication is important for the development of a medical specialty or discipline and is also essential for the improvement of quality of care. In 2010, the Economist Intelligence Unit measured the current environment for end-of-life care services across 40 countries by using the Quality of Death Index across four categories, including Basic End-of-Life Healthcare Environment, Availability of End-of-Life Care, Cost of End-of-Life Care, and Quality of End-of-Life Care. For the overall score, the UK ranked first, Australia was second, the Netherlands seventh, Germany eighth, Canada and the United States tied at ninth place, France 12th, and Taiwan ranked 14th.10 In this study, we found that the most prolific countries/areas publishing hospice palliative care-related documents were also the top performing countries in the Quality of Death measurement according to the Economist Intelligence Unit in 2010. It seems that these countries or areas not only focused on research but also on improvement in hospice palliative care to help terminal patients have better quality of death. Furthermore, we found that during 1993 to 2013, 27,788 documents were published in 232 WoS subject categories. Establishing a hospice palliative care-specific category might be helpful for hospice palliative care-related research and publication.
We found that there were increasing trends of hospice palliative care-related publications during 1993 to 2013 both worldwide and in Taiwan. However, the document publication CAGRs fluctuated from 15.82% to 7.60% to 8.62% during 1993 to 1999, 2000 to 2006, and 2007 to 2013, respectively. For Taiwan, the publication CAGR increased from 15.06% to 17.92% during 2000 to 2006 and 2007 to 2013, respectively. The rising rates of publications in Taiwan may be related to regulation and revisions of the Hospice Palliative Act,11 the hospice palliative care movements that motivated more professionals to become more dedicated to hospice palliative care and researches.
A recent study conducted in France revealed that the main barriers to research in palliative care included lack of time, patient issues, lack of methodological support, and financial limitations.12 Our results showed that the majority of hospice palliative care-related articles were submitted from universities or hospitals affiliated with universities. This may be attributed to the fact that these institutions are responsible for clinical services, teaching, and research. These universities or hospitals may share clinical and research resources with each other, which, in collaboration, may lead to improvements both in hospice palliative care and academic performance.
The multidisciplinary care features of hospice palliative care and patients with different terminal illness receiving care via hospice palliative approaches contribute to the distinct and complex knowledge of this discipline. Various research results from care provision for different terminal illness have been conducted or published around the world. Currently, the main study issues include hospice palliative care for terminal cancer, for noncancer terminal illness, development of hospice palliative care in the community, caregiver burdens, spiritual care, dignity, psychology and bereavement, place of death, policy, and economics.13
Our study had several limitations. First, we only included articles, letters, reviews, proceedings papers, editorial materials, and notes from SCI-E, SCI and SSCI journals. Second, we used the search key words “hospice”, “palliative care”, “end of life care”, and “terminal care,” which might not cover all hospice palliative care-related publications but should cover most such articles. Third, we did not read each paper and therefore could not know the contents of these articles for further analysis.
In conclusion, there were increasing trends of hospice palliative care-related documents published worldwide from 1993 to 2013 and for Taiwan from 1999 to 2013. However, the number of publications from Taiwan was far below those from Japan and several Western countries. The majority of these documents were submitted by universities or hospitals affiliated with universities both worldwide and in Taiwan. Further research is necessary to understand and try to reduce the barriers to hospice palliative care research and publications in Taiwan.
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