Factors associated with home versus institutional death among cancer patients in Connecticut
Factors associated with home versus institutional death among cancer patients in Connecticut
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DOI：
10.1046/j.1532-5415.2001.49154.x
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发表时间：
2001-06-01
影响因子：
6.3
通讯作者：
Bradley, EH
中科院分区：
文献类型：
--
作者：
Gallo, WT;Baker, MJ;Bradley, EH
设计：前瞻性队列研究。设定：1994年康涅狄格州所有成年人死于癌症。研究对象：6,813名符合以下所有标准的人：1994年死于癌症相关原因，曾在康涅狄格州被诊断患有癌症，死亡时年龄在18岁及以上。测量：死亡地点。结果：29%的研究样本死于家中，42%死于医院，17%死于疗养院11%的人死于住院临终关怀机构。多因素分析显示，人口学特征(已婚、女性、白人、居住在较高收入地区)、疾病相关因素(癌症类型、确诊后生存期较长)和健康资源因素(临终关怀提供者更多、病床更少)与在家中死亡有关，而不是在医院或住院临终关怀中。结论：本研究对临床实践和健康规划具有重要意义。这些发现确定了制度化死亡风险较高的群体(男性、未婚个人和那些生活在低收入地区的人)-当患者及其家人更喜欢家庭死亡时，这些群体可能成为可能的干预措施的目标，以促进家庭死亡。此外，研究结果表明，死亡地点受到可用的卫生系统资源的影响。因此，如果要支持家庭死亡，医院床位和临终关怀提供者的相对可用性可能是促进家庭死亡的有效政策工具。
OBJECTIVE: To assess the relationships between home death and a set of demographic, disease-related, and health-resource factors among individuals who died of cancer.DESIGN: Prospective cohort study.SETTING: All adult deaths from cancer in Connecticut during 1994.PARTICIPANTS: Six thousand eight hundred and thirteen individuals who met all of the following criteria: died of a cancer-related cause in 1994, had previously been diagnosed with cancer in Connecticut, and were age 18 and older at the time of death.MEASUREMENT: Site of death.RESULTS: Twenty-nine percent of the study sample died at home, 42% died in a hospital, 17% died in a nursing home, and 11% died in an inpatient hospice facility. Multivariate analysis indicated that demographic characteristics (being married, female, white, and residing in a higher income area), disease-related factors (type of cancer, longer survival postdiagnosis), and health-resource factors (greater availability of hospice providers, less availability of hospital beds) were associated with dying at home rather than in a hospital or inpatient hospice.CONCLUSIONS: The implications of this study for clinical practice and health planning are considerable. The findings identify groups (men, unmarried individuals, and those living in lower income areas) at higher risk for institutionalized death-groups that may be targeted for possible interventions to promote home death when home death is preferred by patients and their families. Further, the findings suggest that site of death is influenced by available health-system resources. Thus, if home death is to be supported, the relative availability of hospital beds and hospice providers may be an effective policy tool for promoting home death.