Advance care planning and home death in patients with advanced cancer: a structured interview analysis
Advance care planning and home death in patients with advanced cancer: a structured interview analysis
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DOI：
10.12968/ijpn.2018.24.9.418
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发表时间：
2018-09-01
影响因子：
1
通讯作者：
Okamoto, Yuko
中科院分区：
文献类型：
--
作者：
Ishikawa, Takako;Fukui, Sakiko;Okamoto, Yuko
背景：在晚期癌症患者中，首选死亡地点和实际死亡地点之间的不一致是很常见的。目的：探讨晚期癌症患者家庭死亡与预先护理计划（ACP）的关系。研究方法：采用结构化访谈法，对来自日本19个家庭访视护理机构的44名初级护士进行了调查，询问了123名接受家庭护理的晚期癌症患者的状态变化，主要结果是死亡地点。结果：123例患者中，16例存活，54例在家中死亡，53例在医院死亡。多变量分析显示，如果：i）医生或护士在整个家访期间实施ACP，（比值比（OR）41.76;置信区间（CI）5.87-297.07）; ii）患者在死亡前或住院时对其预后有足够的了解（OR 7.85; CI 1.18-52.24）;和iii）家庭的基线偏好是在家死亡（OR 0.09; 95% CI 0.01-0.73）。结论：医师或护士对晚期癌症患者实施ACP可能有助于实现家庭死亡。
Background: Discrepancy between preferred and actual place of death is common in patients with advanced cancer. Aim: To investigate the association between advance care planning (ACP) and home death in patients with advanced cancer. Methods: Using structured interviews, 44 primary nurses from 19 home-visit nursing agencies in Japan were asked about status changes for 123 advanced cancer patients receiving home care.The main outcome was the place of death. Results: Of the 123 patients, 16 were alive, 54 died at home and 53 died at hospital. Multivariate analyses revealed that home death was more likely if: i) physicians or nurses practised ACP during the whole home-visit period (odds ratio (OR) 41.76; confidence interval (CI) 5.87-297.07); ii) patients had adequate insight concerning their prognosis just before death or at hospitalisation (OR 7.85; CI 1.18-52.24); and iii) the baseline preference of families was a home death (OR 0.09; 95% CI 0.01-0.73). Conclusion: ACP practiced by physicians or nurses for advanced cancer patients may contribute to achieving home death.