Quality of End-of-Life Care in Low-Income, Uninsured Men Dying of Prostate Cancer
Quality of End-of-Life Care in Low-Income, Uninsured Men Dying of Prostate Cancer
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DOI：
10.1002/cncr25039
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发表时间：
2010-05-01
期刊：
影响因子：
6.2
通讯作者：
Litwin, Mark S.
中科院分区：
文献类型：
--
作者：
Bergman, Jonathan;Chi, Amanda C.;Litwin, Mark S.
背景：对预期参加公共援助计划的弱势男性进行临终关怀质量评估。据推测，临终关怀将是积极的，超过护理质量指南所建议的。方法：该研究纳入了国家资助的公共援助计划中自 2001 年启动以来死亡的所有 60 名低收入、未投保男性。为了衡量临终关怀的质量，收集了有关新化疗方案的实施时间、从最后一次化疗到死亡的时间、死亡前 3 个月内住院和入住重症监护室的人数以及急诊室数量等信息。 死亡前 12 个月内进行的探访。还注意到临终关怀的使用和临终关怀转诊的时间。结果：18 名男性 (30%) 在死亡前参加了临终关怀，平均临终关怀持续了 45 天（标准差，32；范围，2-143 天；中位数，41 天）。两名患者 (11%) 入组时间少于 7 天，没有一名患者入组时间超过 180 天。从最后一剂化疗到死亡的平均时间为104天。死亡后 3 个月内从未开始化疗，只有 2 例 (6%) 是在死亡后 2 周内进行的最终化疗方案。医院资源的使用（急诊室就诊、住院和重症监护病房住院）均较低（平均值分别为 1.0 +/- 1.0、0.65 +/- 0.82 和 0.03 +/- 0.18）。结论：参加全州综合援助计划的死于前列腺癌的弱势男性的临终关怀是高质量的。癌症 2010；116：2126-31。 (C) 2010 美国癌症协会
BACKGROUND: The quality of end-of-life care was assessed in disadvantaged men prospectively enrolled in a public assistance program. That end-of-life care would be aggressive, moreso than recommended by quality-of-care guidelines, was hypothesized. METHODS: Included in the study were all 60 low-income, uninsured men in a state-funded public assistance program who had died since its inception in 2001. To measure quality of end-of-life care, information was collected regarding timing of the institution of new chemotherapeutic regimens, time from administration of last chemotherapy dose to death, the number of inpatient admissions and intensive care unit stays made in the 3 months preceding death, and the number of emergency room visits made in the 12 months before dying. Also noted were hospice use and the timing of hospice referrals. RESULTS: Eighteen men (30%) enrolled in hospice before death and the average hospice stay lasted 45 days (standard deviation, 32; range, 2-143 days; median, 41 days). Two patients (11%) were enrolled for fewer than 7 days, and none were enrolled for more than 180 days. The average time from administration of the last dose of chemotherapy to death was 104 days. Chemotherapy was never initiated within 3 months of death, and in only 2 instances (6%) was the final chemotherapeutic regimen administered within 2 weeks of dying. Use of hospital resources (emergency room visits, inpatient admissions, and intensive care unit stays) was uniformly low (mean, 1.0 +/- 1.0, 0.65 +/- 0.82, and 0.03 +/- 0.18, respectively). CONCLUSIONS: End-of-life care in disadvantaged men dying of prostate cancer, who enroll in a comprehensive statewide assistance program, is high-quality. Cancer 2010;116:2126-31. (C) 2010 American Cancer Society