Does dying at home influence the good death of terminal cancer patients?
Does dying at home influence the good death of terminal cancer patients?
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DOI：
10.1016/j.jpainsymman.2007.01.004
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发表时间：
2007-11-01
影响因子：
4.7
通讯作者：
Chiu, Tai-Yuan
中科院分区：
文献类型：
--
作者：
Yao, Chien-An;Hu, Wen-Yu;Chiu, Tai-Yuan
为了研究在许多社区医疗资源有限的情况下，在家中死亡是否会影响晚期癌症患者实现良好死亡的可能性，本研究调查了两组死亡地点不同的患者实现良好死亡与良好死亡服务绩效之间的关系，并探讨了与这种关系相关的可能因素。374例晚期癌症患者连续入住姑息治疗病房。研究中使用了两种工具，即良好死亡量表和良好死亡服务审计量表。374例患者的平均年龄为65.45 ± 14.77岁。在入院时（t =-5.741，P < 0.001）和死亡前（t =-3.027，P <0.01），家中死亡组（n = 307）的总良好死亡评分显著高于医院死亡组（n = 67）。而在“身体舒适度”项目上，家中死亡组死亡前评分低于医院死亡组（P = 0.185）。在临终关怀服务审计量表中，除“社会支持的持续性”分量表外（4.72 vs.4.61，P = 0.132），家庭死亡组的各分量表得分及总分均显著高于医院死亡组。丧亲支持（比值比= 1.01，95%可信区间= 0.62-7.39;多元回归），缓解焦虑（0.81，0.46-1.15）、决策参与（0.61，0.26-0.95）、临终愿望的实现（0.45，0.08-0.82）和生存时间（0.00，0.00-0.01）是良好死亡评分的独立相关因素（解释方差的35.8%）。然而，死亡的地点不在模型中。研究结论表明，姑息性家庭护理的必要性，以加强身体护理的能力。此外，早期将姑息治疗纳入抗癌治疗可以导致更好的死亡准备和良好的死亡服务，从而有助于实现良好的死亡。
To investigate whether dying at home influences the likelihood that a terminal cancer patient will achieve a good death despite the limited medical resources available in many communities, this study investigated the relationship between the achievement of a good death and the performance of good-death services in two groups with different places of death, and explored the possible factors associated with this relationship. Three hundred and seventy-four consecutive patients with terminal cancers admitted to a palliative care unit were enrolled. Two instruments, the good-death scale and the audit scale for good-death services, were used in the study. Mean age of the 374 patients was 65.45 +/- 14.77years. The total good-death score in the home-death group (n = 307) was significantly higher than that in the hospital-death group (n 67), both at the time of admission (t = -5.741, P < 0.001) and prior to death (t = -3.027, P < 0.01). However the score of item "degree of physical comfort" assessed prior to death in the home-death group was lower than that in the hospital-death group (P = 0.185). As to the audit scale for good-death services, each subscale score and total scores in the home-death group were significantly higher than that in the hospital-death group, with the exception of the subscale "continuity of social support" (4.72 vs. 4.61, P = 0.132). Bereavement support (odds ratio = 1.01, 95% confidence interval = 0.62-7.39; multiple regression), alleviation of anxiety (0.81, 0.46-1.15), decision-making participation (0.61, 0.26-0.95), fulfillment of last wish (0.45, 0.08-0.82), and survival time (0.00, 0.00-0.01) were independent correlates of the good-death score (35.8% of explained variance). However, the place of death was not in the model. The study conclusively suggests the necessity for palliative home care to strengthen the competence of physical care. Moreover, earlier incorporation of palliative care into anticancer therapies can lead to better death preparation and good-death services, and thus be helpful to achieve a good death.