Trends in quality of end-of-life care for Taiwanese cancer patients who died in 2000-2006
Trends in quality of end-of-life care for Taiwanese cancer patients who died in 2000-2006
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DOI：
10.1093/annonc/mdn602
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发表时间：
2009-02-01
影响因子：
50.5
通讯作者：
Liu, T. -W.
中科院分区：
文献类型：
--
作者：
Tang, S. T.;Wu, S. -C.;Liu, T. -W.
背景：在整个亚洲国家，癌症患者接受的临终护理质量从未针对所有年龄段和癌症群体进行过探讨。患者和方法：回顾性队列研究，调查 2000-2006 年死亡的 242 530 名台湾癌症患者的临终护理质量趋势。结果：在生命的最后一个月，癌症护理往往变得越来越积极，如 (i) 密集使用 化疗（15.45％-17.28％），（ii）频繁急诊室就诊（15.69％-20.99％）和住院时间> 14天（41.48％-46.20％），（iii）入住重症监护病房（10.04％-12.41％），以及（iv）医院死亡（59.11％-65.40％）。心肺复苏（13.09%-8.41%）、插管（26.01%-21.07%）和机械通气（27.46%-27.05%）的使用减少，而临终关怀服务的使用大幅增加（7.34%-16.83%）。在接受临终关怀服务的人中，生命最后 3 天转介至临终关怀服务的比率从 17.88% 下降至 17.13%，但在调整选定的协变量后仍保持稳定。结论：台湾癌症死者的临终关怀质量大大低于之前报告的质量，也低于建议作为在临终时不提供过度积极护理的基准的质量。
Background: Quality of end-of-life care received by cancer patients has never been explored in an entire Asian country for all ages and cancer groups.Patients and methods: Retrospective cohort study to examine trends in quality of end-of-life care among a cohort of 242 530 Taiwanese cancer patients who died in 2000-2006.Results: In the last month of life, cancer care tended to become increasingly aggressive as shown by (i) intensive use of chemotherapy (15.45%-17.28%), (ii) frequent emergency room visits (15.69%-20.99%) and > 14-day hospital stays (41.48%-46.20%), (iii) admissions to intensive care units (10.04%-12.41%), and (iv) hospital deaths (59.11%-65.40%). Use of cardiopulmonary resuscitation (13.09%-8.41%), intubation (26.01%-21.07%), and mechanical ventilation (27.46%-27.05%) decreased, whereas use of hospice services increased considerably (7.34%-16.83%). Among those receiving hospice services, rates of referrals to hospice services in the last 3 days of life decreased from 17.88% to 17.13% but remained steady after adjusting for selected covariates.Conclusions: The quality of end-of-life care for Taiwanese cancer decedents was substantially inferior to that previously reported and to that recommended as benchmarks for not providing overly aggressive care near the end of life.