Preferred and Actual Location of Death: What Factors Enable a Preferred Home Death?
Preferred and Actual Location of Death: What Factors Enable a Preferred Home Death?
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DOI：
10.1089/jpm.2015.0177
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发表时间：
2015-12-01
影响因子：
2.8
通讯作者：
Flowerdew, Gordon
中科院分区：
文献类型：
--
作者：
Burge, Fred;Lawson, Beverley;Flowerdew, Gordon
背景：满足病人对死亡地点的偏好是持续的临终关怀的兴趣。在那些表达偏好的人中，大多数人更喜欢回家。然而，大多数死亡发生在机构环境中。目的：本研究的目的是报告死于慢性疾病的成年新斯科舍省人的最后一个首选和实际死亡地点之间的一致性，并确定与实现首选的家庭死亡相关的个人，疾病相关和环境因素。方法：本研究采用以人口为基础的死亡率追踪电话调查访谈。受试者是2009年6月至2011年5月期间在加拿大新斯科舍省死于晚期慢性病的成年人（18岁以上）（n=1316）的合格死亡证明确定的知情人（近亲），他们了解死者生命最后一个月的护理情况。一致性被评估为死者是否在他们首选的死亡地点死亡。在死者喜欢在家死亡，个人，疾病相关的，和环境风险因素的多变量分析，以确定预测的家庭死亡的成就。结果：在所有表达偏好的人（n=606）中，52%的人死于他们的首选地点（kappa：0.29）。独立的因素有助于实现首选的家庭死亡的情感需求得到满足，护理和家庭医生家访，姑息治疗计划的参与，并在家里的最后一个月的大部分时间。结论：这项研究确定了初级和综合保健的要素，解决了首选和实际护理地点之间的差距。
Background: Fulfillment of patient preferences for location of dying is of continued end-of-life care interest. Of those voicing a preference, most prefer home. However the majority of deaths occur in an institutional setting. Objectives: The study objective was to report on the congruence between the last preferred and actual location of death among adult Nova Scotians who died from chronic disease, and to identify individual, illness-related, and environmental factors associated with achieving a preferred home death. Methods: The study employed a population-based mortality follow-back telephone survey interview. Subjects were eligible death certificate identified informants (next-of-kin) of adults (aged 18+) (n=1316) who died of advanced chronic diseases in the Canadian province of Nova Scotia between June 2009 and May 2011 who were knowledgeable about the decedent's care over the last month of life. Congruence was assessed as to whether or not the decedent died in their preferred death location. Among decedents preferring a home death, individual, illness-related, and environmental risk factor multivariable analyses were used to identify predictors of home death achievement. Results: Among all who voiced a preference (n=606), 52% died in their preferred location (kappa: 0.29). Factors contributing independently to achievement of a preferred home death were emotional needs being met, nursing and family physician home visits, palliative care program involvement, and being at home for the majority of the last month. Conclusions: This study identifies elements of primary and integrated care that address the gap between preferred and actual place of care.