Inequity in the provision of and access to palliative care for cancer patients. Results from the Italian survey of the dying of cancer (ISDOC).
Inequity in the provision of and access to palliative care for cancer patients. Results from the Italian survey of the dying of cancer (ISDOC).
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DOI：
10.1186/1471-2458-7-66
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发表时间：
2007-04-27
影响因子：
4.5
通讯作者：
ISDOC Study Group
中科院分区：
文献类型：
--
作者：
Beccaro M;Costantini M;Merlo DF;ISDOC Study Group
所有国家都以不同的强度和方式制定了姑息治疗服务和方案。一些研究报告指出，各国之间和各国内部姑息治疗服务的提供和提供存在地理差异，一些弱势群体被排除在这些服务之外。这项调查估计了意大利癌症患者生命最后三个月的护理场所分布情况、在家中和医院接受姑息护理支持的比例以及与转诊到姑息护理服务相关的因素。这是一项死亡率跟踪调查，涉及2，000例癌症死亡，采用2阶段概率抽样确定，代表全国。通过访谈从非专业护理人员处收集患者的经验信息，使用改编版的VOICES问卷。访谈的一部分涉及护理场所和向病人提供的姑息治疗服务。多元逻辑回归分析，以确定姑息治疗服务使用的决定因素。67%的确定的照顾者（n = 1，271）获得了有效的采访。大多数意大利癌症患者在家中（91%）或医院（63%）接受治疗，但在国内存在很大差异。只有14%的意大利癌症患者在家中接受护理，而住院患者中只有20%接受姑息治疗。家庭患者接受这些服务的主要决定因素是：诊断和死亡之间的时间间隔较长（P = 0.01）和照顾者的高教育水平（P = 0.01）;住院患者的年龄较低（P < 0.01）和照顾者的高教育水平（P = 0.01）。在意大利，姑息治疗服务在全国范围内并不均等。此外，获得姑息治疗服务与患者及其护理人员的社会人口特征密切相关。意大利决策者需要在全国范围内平等提供姑息治疗，以满足所有癌症患者的需求。
The palliative services and programs have been developed with different intensity and modalities in all countries. Several studies have reported that a geographic variation in the availability and provision of palliative care services between and within countries exists, and that a number of vulnerable groups are excluded from these services. This survey estimates the distribution of places of care for Italian cancer patients during the last three months of their lives, the proportion receiving palliative care support at home and in hospital, and the factors associated with the referral to palliative care services. This is a mortality follow-back survey of 2,000 cancer deaths identified with a 2-stage probability sample, representative of the whole country. Information on patients' experience was gathered from the non-professional caregiver through an interview, using an adapted version of the VOICES questionnaire. A section of the interview concerned the places of care and the palliative care services provided to patients. Multivariate logistic regression analyses were conducted to identify the determinants of palliative care service use. Valid interviews were obtained for 67% of the identified caregivers (n = 1,271). Most Italian cancer patients were cared for at home (91%) or in hospital (63%), but with substantial differences within the country. Only 14% of Italian cancer patients cared for at home against 20% of those admitted to hospital, received palliative care support. The principal determinants identified for receiving these service were: an extended interval between diagnosis and death (P = 0.01) and the caregiver's high educational level (P = 0.01) for patients at home; the low patient's age (P < 0.01) and the caregiver's high educational level (P = 0.01) for patients in hospital. In Italy palliative care services are not equally available across the country. Moreover, access to the palliative care services is strongly associated with socio demographic characteristics of the patients and their caregivers. Italian Policy-makers need to equalise palliative care provision and access across the country to meet the needs of all cancer patients.
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影响因子：
6.3
作者：
Braveman, P;Gruskin, S
通讯作者：
Gruskin, S
影响因子：
6.3
作者：
Addington-Hall, J;Walker, L;McCarthy, M
通讯作者：
McCarthy, M
影响因子：
4.4
作者：
Burge, F;Johnston, G;Cummings, I
通讯作者：
Cummings, I
影响因子：
4.7
作者：
Middlewood, S;Gardner, G;Gardner, A
通讯作者：
Gardner, A
影响因子：
4.4
作者：
Costantini, M;Beccaro, M;Merlo, F
通讯作者：
Merlo, F