Determinants of the place of death among terminally ill cancer patients under home hospice care in Japan
Determinants of the place of death among terminally ill cancer patients under home hospice care in Japan
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DOI：
10.1191/0269216303pm782oa
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发表时间：
2003-01-01
影响因子：
4.4
通讯作者：
Toshie, M
中科院分区：
文献类型：
--
作者：
Fukui, S;Kawagoe, H;Toshie, M
虽然癌症晚期患者的死亡地点受多种因素影响，但很少有研究系统地调查其决定因素。本研究旨在探讨日本家庭照护机构护理的晚期癌症患者的社会人口学、临床及支持网络变量对其死亡地点的影响。在259家家庭护理机构的528名患者中，342名（65%）在家中死亡，186名（35%）在医院死亡。在多变量逻辑回归模型中,表达了渴望接受家庭护理的患者转诊(比值比(或),95%可信区间(CI): 2.19, 1.09 - 4.40)除了家庭照顾者的渴望同样的(或者,95%置信区间CI: 3.19, 1.75 - 5.81),谁有超过一个家庭照顾者(或者,95%置信区间CI: 2.28, 1.05 - 4.94),他的支持他们的家庭医生(或者,95%置信区间CI: 2.23, 1.21 - 4.08),谁又没有(或者,95%置信区间CI:0.04, 0.02 - 0.07)，在居家安宁疗护的稳定阶段接受居家安宁疗护护士家访次数较多的患者（OR, 95% CI: 1.25, 1.02 - 1.53），以及在死亡前最后一周处于最大功能依赖状态的患者（OR, 95% CI: 8.60, 4.97 - 14.89）更有可能在家中死亡。总体而言，该模型可以准确地对95%的死亡地点进行分类，这高于其他已发表的研究。更清楚地了解可能影响晚期癌症患者死亡地点的因素，将使医疗保健专业人员能够修改医疗保健系统，并量身定制有效的干预措施，以帮助患者在他们喜欢的地方死亡。
Although the place of death of patients with terminal cancer is influenced by multiple factors, few studies have systematically investigated its determinants. The purpose of this study was to examine the influence of the patients' sociodemographic, clinical and support network variables on the place of death of terminally ill cancer patients under the care of home care agencies in Japan. Among 528 patients from 259 home care agencies, 342 (65%) died at home and 186 (35%) died at a hospital. From the multivariate logistic regression model, patients who expressed the desire for receiving home care at referral [ odds ratio ( OR), 95% confidence interval (CI): 2.19, 1.09 - 4.40] in addition to the family caregiver's desire for the same ( OR, 95% CI: 3.19, 1.75 - 5.81), who had more than one family caregiver ( OR, 95% CI: 2.28, 1.05 - 4.94), who had the support of their family physician ( OR, 95% CI: 2.23, 1.21 - 4.08), who were never rehospitalized ( OR, 95% CI: 0.04, 0.02 - 0.07), who received more home visits by the home hospice nurse during the stable phase under home hospice care ( OR, 95% CI: 1.25, 1.02 - 1.53), and who were in the greatest functionally dependent status during the last week prior to death ( OR, 95% CI: 8.60, 4.97 - 14.89) were more likely to die at home. Overall, this model could accurately classify 95% of the places of death, which is higher than other published studies. A clearer understanding of factors that might influence the place of death of terminally ill cancer patients would allow healthcare professionals to modify healthcare systems and tailor effective interventions to help patients die at their place of preference.