Social and clinical determinants of preferences and their achievement at the end of life: prospective cohort study of older adults receiving palliative care in three countries.
Social and clinical determinants of preferences and their achievement at the end of life: prospective cohort study of older adults receiving palliative care in three countries.
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DOI：
10.1186/s12877-017-0648-4
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发表时间：
2017-11-23
期刊：
影响因子：
4.1
通讯作者：
BuildCARE
中科院分区：
文献类型：
--
作者：
Higginson IJ;Daveson BA;Morrison RS;Yi D;Meier D;Smith M;Ryan K;McQuillan R;Johnston BM;Normand C;BuildCARE
实现选择被认为是一个质量标志。但人们对是什么影响了偏好，尤其是老年人的偏好，知之甚少。我们的目的是确定和比较，在三个国家，与死亡地点和治疗的偏好，以及实际的死亡地点相关的因素。我们从伦敦、都柏林、纽约的医院多专业姑息治疗服务机构招募了年龄≥65岁的成年人，并对他们进行了>17个月的随访。所有服务都提供医院病房咨询、对现有临床团队的支持、门诊服务，并从国家卫生服务局和/或相关保险报销中获得资金。纽约服务处另外还有10张住院病床。所有人都与病人一起工作，并将病人转诊到当地的收容所。面对面的访谈记录了最喜欢和最不喜欢的死亡地点，治疗目标的优先顺序，人口统计学和临床信息，使用有效的问卷。多变量和多水平分析评估相关因素。招募了138名老年人（伦敦64名，都柏林59名，纽约15名），110名在随访期间死亡。家庭是最首选的死亡地点（77/138，56%），其次是住院姑息治疗/临终关怀单位（22%）。医院是最不喜欢的（35/138，25%），其次是疗养院（20%）和家庭（16%）;临终关怀/姑息治疗病房很少是最不喜欢的（4%）。大多数受访者优先考虑提高生活质量，无论是单独（54%），还是与延长寿命（39%）同等重要;只有少数人（3%）选择延长寿命。各国之间没有显著差异。与居家偏好相关的主要因素为：癌症诊断（OR 3.72，95% CI 1.40-9.90）和与他人同居（OR 2.19，1.33-3.62）。非癌症诊断的成年人更喜欢姑息治疗单位（OR 2.39，1.14-5.03）。相反，功能独立性（OR 1.05，1.04-1.06）和重视生活质量（OR 3.11，2.89-3.36）与在家死亡有关。偏好和成就之间存在不匹配-在85名更喜欢家庭或姑息治疗单位的人中，19人（25%）实现了他们的首选。虽然家庭是最常见的第一偏好，但它是两极分化的，16%的人最不喜欢。住院病人姑息治疗病房成为第二个最受欢迎的地方，很少是最不受欢迎的，但对于那些想死在那里的人来说，往往没有实现。影响陈述偏好和满足偏好的因素不同。现有的服务，特别是社区支助和姑息治疗单位，需要扩大。将实际死亡地点与满足患者和家属需求的能力进行对比，可能是比简单地“实现偏好”更好的质量指标。本文的在线版本（10.1186/s12877-017-0648-4）包含补充材料，可供授权用户使用。
Achieving choice is proposed as a quality marker. But little is known about what influences preferences especially among older adults. We aimed to determine and compare, across three countries, factors associated with preferences for place of death and treatment, and actual site of death. We recruited adults aged ≥65-years from hospital-based multiprofessional palliative care services in London, Dublin, New York, and followed them for >17 months. All services offered consultation on hospital wards, support for existing clinical teams, outpatient services and received funding from their National Health Service and/or relevant Insurance reimbursements. The New York service additionally had 10 inpatient beds. All worked with and referred patients to local hospices. Face-to-face interviews recorded most and least preferred place of death, treatment goal priorities, demographic and clinical information using validated questionnaires. Multivariable and multilevel analyses assessed associated factors. One hundred and thirty eight older adults (64 London, 59 Dublin, 15 New York) were recruited, 110 died during follow-up. Home was the most preferred place of death (77/138, 56%) followed by inpatient palliative care/hospice units (22%). Hospital was least preferred (35/138, 25%), followed by nursing home (20%) and home (16%); hospice/palliative care unit was rarely least preferred (4%). Most respondents prioritised improving quality of life, either alone (54%), or equal with life extension (39%); few (3%) chose only life extension. There were no significant differences between countries. Main associates with home preference were: cancer diagnosis (OR 3.72, 95% CI 1.40–9.90) and living with someone (OR 2.19, 1.33–3.62). Adults with non-cancer diagnoses were more likely to prefer palliative care units (OR 2.39, 1.14–5.03). Conversely, functional independence (OR 1.05, 1.04–1.06) and valuing quality of life (OR 3.11, 2.89–3.36) were associated with dying at home. There was a mismatch between preferences and achievements – of 85 people who preferred home or a palliative care unit, 19 (25%) achieved their first preference. Although home is the most common first preference, it is polarising and for 16% it is the least preferred. Inpatient palliative care unit emerges as the second most preferred place, is rarely least preferred, and yet was often not achieved for those who wanted to die there. Factors affecting stated preferences and met preferences differ. Available services, notably community support and palliative care units, require expansion. Contrasting actual place of death with capacity for meeting patient and family needs may be a better quality indicator than simply ‘achieved preferences’. The online version of this article (10.1186/s12877-017-0648-4) contains supplementary material, which is available to authorized users.
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影响因子：
3.1
作者：
Gomes B;Calanzani N;Gysels M;Hall S;Higginson IJ
通讯作者：
Higginson IJ
“对他人的负担”是公众对晚期癌症的关注：在七个欧洲国家进行的比较调查。
影响因子：
3.8
作者：
Bausewein C;Calanzani N;Daveson BA;Simon ST;Ferreira PL;Higginson IJ;Bechinger-English D;Deliens L;Gysels M;Toscani F;Ceulemans L;Harding R;Gomes B;PRISMA
通讯作者：
PRISMA
影响因子：
6.3
作者：
Enguidanos, Susan;Kogan, Alexis M. Coulourides;Lorenz, Karl
通讯作者：
Lorenz, Karl
影响因子：
4.4
作者：
Gomes, Barbara;Higginson, Irene J.
通讯作者：
Higginson, Irene J.
DOI：
10.1046/j.1532-5415.2001.49154.x
发表时间：
2001-06-01
影响因子：
6.3
作者：
Gallo, WT;Baker, MJ;Bradley, EH
通讯作者：
Bradley, EH