Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study
Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study
复制标题
DOI：
10.1186/s12916-015-0466-5
复制
发表时间：
2015-10-09
期刊：
影响因子：
9.3
通讯作者：
Higginson, Irene J.
中科院分区：
文献类型：
--
作者：
Gomes, Barbara;Calanzani, Natalia;Higginson, Irene J.
背景：研究表明，大多数晚期癌症患者倾向于在家中死亡。然而，并不是所有人都有同样的机会，而且尚不清楚在家死亡是否更好。本研究旨在确定死亡地点、所使用的卫生服务与痛苦、平静感和悲伤强度之间的关系。方法：对英国伦敦352例死于医院（n = 177）或家中（n = 175）的癌症患者的死亡率进行随访研究。从死亡登记中确定的丧失亲属完成了一份问卷，包括对患者生命最后一周的痛苦与平静以及他们自己的悲伤强度的有效测量。我们确定了影响在家死亡的因素，以及死亡地点与痛苦、安宁和悲伤之间的联系。结果：大多数人（80%）的死亡地点是他们生命最后一周居住的地方。四个因素解释了91%的家庭死亡：患者偏好、亲属偏好、家庭姑息治疗或地区/社区护理。当亲属意识到自己无法治愈且患者与家人讨论自己的选择时，在家死亡的倾向也会增加。在医院死亡与更多的住院天数、更少的全科医生（GP）家访以及更少的亲属请假天数有关。调整混杂因素后，在家中去世的患者在生命的最后一周经历了相似的疼痛水平，但更平静（有序对数优势比0.69,P = 0.007）。与在医院死亡的患者相比，他们的亲属的悲伤程度较低（贝塔系数，死亡时为-0.15，问卷完成时为-0.14,P = 0.02）。结论：该研究表明，在家中死亡比在医院更好地获得安宁和悲伤，但需要讨论偏好，全科医生家访，并给予亲属休息时间。
Background: Studies show that most patients with advanced cancer prefer to die at home. However, not all have equal chances and the evidence is unclear on whether dying at home is better. This study aims to determine the association between place of death, health services used, and pain, feeling at peace, and grief intensity.Methods: Mortality follow-back study of 352 cancer patients who died in hospital (n = 177) or at home (n = 175) in London, UK. Bereaved relatives identified from death registrations completed a questionnaire including validated measures of patient's pain and peace in the last week of life and their own grief intensity. We determined factors influencing death at home, and associations between place of death and pain, peace, and grief.Results: Where people died was, for most (80 %), the place where they lived during their last week of life. Four factors explained > 91 % of home deaths: patient's preference, relative's preference, home palliative care, or district/community nursing. The propensity of death at home also increased when the relative was aware of incurability and the patient discussed his/her preferences with family. Dying in hospital was associated with more hospital days, fewer general practitioner (GP) home visits, and fewer days taken off work by relatives. Adjusting for confounders, patients who died at home experienced similar pain levels but more peace in their last week of life (ordered log odds ratio 0.69, P = 0.007). Grief was less intense for their relatives than for those of patients who died in hospital (beta, -0.15 around time of death and -0.14 at questionnaire completion, P = 0.02).Conclusion: The study suggests that dying at home is better than hospital for peace and grief, but requires a discussion of preferences, GP home visits, and relatives to be given time off work.