Trends and racial disparities in aggressive end-of-life care for a national sample of women with ovarian cancer.
Trends and racial disparities in aggressive end-of-life care for a national sample of women with ovarian cancer.
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作者：
Mullins MA;Ruterbusch JJ;Clarke P;Uppal S;Wallner LP;Cote ML
临床景观已经转向对卵巢癌妇女的生命末期护理不那么积极。然而，使用积极的生命周期结束服务的情况是否有所下降尚不清楚。我们使用监测、流行病学和最终结果（SEER）关联的医疗保险数据集，评估了卵巢癌妇女临终关怀的当前国家趋势和种族差异。我们确定了7，756名66岁以上的医疗保险受益人，他们在2007年至2016年间死于卵巢癌。我们使用多变量logistic回归分析了晚期或未使用临终关怀、一次以上急诊（艾德）就诊、重症监护室（ICU）入院、一次以上住院、终末期住院、化疗和侵入性和/或延长生命手术的趋势和种族差异。中位临终关怀住院时间并没有随着时间的推移而变化，但是越来越多的妇女被送进ICU，并在生命的最后一个月内多次接受艾德检查（p<.001）。在临终时不参加临终关怀和终末住院治疗的人数随着时间的推移而减少（p<0.001）。非白人女性更有可能接受积极的临终关怀，特别是医院相关的利用和生命延长手术，而与非西班牙裔白色女性相比，非西班牙裔黑人女性更有可能接受>1次艾德访视（OR 2.04 CI 1.57-2.64）或生命延长手术（OR 1.89 CI 1.45-2.48）。尽管临床指南和越来越强调减少积极的临终关怀，积极的临终关怀的使用与卵巢癌的妇女仍然存在，护理是最积极的非白人妇女。尽管最近强调减少积极的临终关怀，没有/晚期临终关怀的使用，积极的治疗和不适当的医院利用持续存在于卵巢癌妇女谁是在生命的尽头，这种护理是最积极的非白人妇女。
The clinical landscape has moved towards less aggressive end of life care for women with ovarian cancer. However, whether there has been a decline in the use of aggressive end of life services is unknown. We evaluated current national trends and racial disparities in end-of-life care among women with ovarian cancer, using the Surveillance, Epidemiology and End Results (SEER) linked Medicare dataset. We identified 7,756 Medicare beneficiaries over age 66 with ovarian cancer dying between 2007 and 2016. We examined trends and racial disparities in late or no hospice use, more than one emergency department (ED) visit, intensive care unit (ICU) admission, more than one hospitalization, terminal hospitalization, chemotherapy, and invasive and/or life extending procedures using multivariable logistic regression. The median hospice length of stay did not change over time, however women were increasingly admitted to the ICU and had multiple ED visits in the last month of life (p<.001). Not enrolling in hospice at the end-of-life and terminal hospitalizations decreased over time (p<.001). Nonwhite women were more likely to receive aggressive end of life care, particularly for hospital-related utilization and life extending procedures, whereas non-Hispanic Black women were more likely to have >1 ED visits (OR 2.04 CI 1.57-2.64) or life extending procedures (OR 1.89 CI 1.45-2.48) compared to non-Hispanic White women. Despite clinical guidelines and increasing emphasis on reducing aggressive end of life care, the use of aggressive end of life care for women with ovarian cancer persists, and care is most aggressive for Nonwhite women. Despite the recent emphasis on reducing aggressive end of life care, no/late hospice use, aggressive treatment, and inappropriate hospital utilization persist among women with ovarian cancer who are at the end of life, and this care is most aggressive for Nonwhite women.
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DOI：
10.1377/hlthaff.2011.0650
发表时间：
2012-04
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Morden NE;Chang CH;Jacobson JO;Berke EM;Bynum JP;Murray KM;Goodman DC
通讯作者：
Goodman DC
影响因子：
4.7
作者：
Dzeng, Elizabeth;Dohan, Daniel;Ritchie, Christine S.
通讯作者：
Ritchie, Christine S.
影响因子：
4.7
作者：
Brown, Alaina J.;Sun, Charlotte C.;Bodurka, Diane C.
通讯作者：
Bodurka, Diane C.
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL
老年胰腺癌患者临终关怀的模式和预测因素。
影响因子：
4
作者：
Nipp RD;Tramontano AC;Kong CY;Hur C
通讯作者：
Hur C