A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on?
A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on?
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DOI：
10.1186/s12904-016-0119-2
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发表时间：
2016-05-10
影响因子：
3.1
通讯作者：
Semmens JB
中科院分区：
文献类型：
--
作者：
Rosenwax L;Spilsbury K;McNamara BA;Semmens JB
从历史上看，与其他限制生命的疾病相比，死于癌症的人获得专科姑息治疗的比例更大。最近，采取了各种措施，改善死于非癌症疾病的人获得姑息治疗的机会。很少有严格的基于人口的研究，记录姑息治疗服务提供的变化相对于患者谁可以受益于这种服务的数量。一项回顾性队列研究，对2009- 2010年因癌症、心力衰竭、肾衰竭、肝功能衰竭、慢性阻塞性肺病、阿尔茨海默病、运动神经元疾病、帕金森病、亨廷顿病和/或艾滋病毒/艾滋病死亡的潜在原因的患者生命的最后一年进行研究。死者接受专科姑息治疗的比例与2000-02年队列进行了比较。使用逻辑回归模型确定与获得专科姑息治疗相关的社会和人口统计学因素。有12，817例死亡纳入队列; 7166例（56%）死于癌症，527例（4%）死于癌症和非癌症疾病，5124例（40%）死于非癌症疾病。总体而言，46.3%的死者接受了社区和/或医院的专科姑息治疗; 10年前报告的专科姑息治疗增加了3.5%（95%CI 2.3-4.7）。大多数（69%; n = 4928）癌症死者在生命的最后一年接受姑息治疗。只有14%（n = 729）的非癌症死亡者接受了专科姑息治疗，然而，这代表了10年前同一死亡者组报告的专科姑息治疗增加了6.1%（95%CI 4.9-7.3）。与心力衰竭死亡者相比，观察到癌症死亡者获得姑息治疗的几率增加（OR 10.5; 95% CI 9.1-12.2）、肾衰竭（OR 1.5; 95% CI 1.3-1.9）、肝衰竭（OR 2.3; 95% CI 1.7-3.3）或运动神经元疾病（OR 4.5; 95% CI 3.1-6.6）。生活在大城市，是女性，有伴侣和生活在私人住宅与获得专科姑息治疗的几率增加有关。在西澳大利亚州，获得专科姑息治疗服务的人数有了小幅但显著的增加，特别是在非癌症死亡患者中。本文的在线版本（doi：10.1186/s12904-016-0119-2）包含补充材料，可供授权用户使用。
Historically, specialist palliative care has been accessed by a greater proportion of people dying with cancer compared to people with other life-limiting conditions. More recently, a variety of measures to improve access to palliative care for people dying from non-cancer conditions have been implemented. There are few rigorous population-based studies that document changes in palliative care service delivery relative to the number of patients who could benefit from such services. A retrospective cohort study of the last year of life of persons with an underlying cause of death in 2009–10 from cancer, heart failure, renal failure, liver failure, chronic obstructive pulmonary disease, Alzheimer’s disease, motor neurone disease, Parkinson’s disease, Huntington’s disease and/or HIV/AIDS. The proportion of decedents receiving specialist palliative care was compared to a 2000–02 cohort. Logistic regression models were used identify social and demographic factors associated with accessing specialist palliative care. There were 12,817 deaths included into the cohort; 7166 (56 %) from cancer, 527 (4 %) from both cancer and non-cancer conditions and 5124 (40 %) from non-cancer conditions. Overall, 46.3 % of decedents received community and/or hospital based specialist palliative care; a 3.5 % (95 % CI 2.3–4.7) increase on specialist palliative care access reported ten years earlier. The majority (69 %; n = 4928) of decedents with cancer accessed palliative care during the last year of life. Only 14 % (n = 729) of decedents with non-cancer conditions accessed specialist palliative care, however, this represented a 6.1 % (95 % CI 4.9–7.3) increase on the specialist palliative care access reported for the same decedent group ten years earlier. Compared to decedents with heart failure, increased odds of palliative care access was observed for decedents with cancer (OR 10.5; 95 % CI 9.1–12.2), renal failure (OR 1.5; 95 % CI 1.3–1.9), liver failure (OR 2.3; 95 % CI 1.7–3.3) or motor neurone disease (OR 4.5; 95 % CI 3.1–6.6). Living in major cities, being female, having a partner and living in a private residence was associated with increased odds of access to specialist palliative care. There is small but significant increase in access to specialist palliative care services in Western Australia, specifically in patients dying with non-cancer conditions. The online version of this article (doi:10.1186/s12904-016-0119-2) contains supplementary material, which is available to authorized users.