Where do you want to spend your last days of life? Low concordance between preferred and actual site of death among hospitalized adults.
Where do you want to spend your last days of life? Low concordance between preferred and actual site of death among hospitalized adults.
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DOI：
10.1002/jhm.2018
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发表时间：
2013-04
影响因子：
2.6
通讯作者：
Kutner J
中科院分区：
文献类型：
--
作者：
Fischer S;Min SJ;Cervantes L;Kutner J
在美国，死亡经常发生在机构中，尽管绝大多数人表示他们更愿意死在家里。迄今为止，很少有研究考察个人偏好与实际死亡地点的比较情况。确定首选死亡地点和实际死亡地点之间的一致性，并检查独立预测因素的一致性。观察性队列研究。三个地区医院，包括安全网医院、退伍军人医院和学术三级转诊中心。 2003 年至 2005 年期间，共有 458 名成年患者接受普通医疗服务。患者被问及他们更愿意在哪里度过生命的最后几天。 2005 年至 2009 年死亡日期和实际地点的数据是从医院记录和死亡证明中收集的。大多数患者宁愿在家中去世（75% n = 343）。与疗养院或住院临终关怀中心相比，低收入和已婚与在家中死亡显着相关（分别为 OR 2.71 95% CI 1.30–5.67 和 OR 2.44 95% CI 1.14–5.21）。在随访期间死亡的 123 名患者中，大多数 (66% n = 80) 死于机构环境中。首选死亡地点与实际死亡地点之间的总体一致性仅为 37% (n = 41)。女性性别与首选死亡地点和实际死亡地点之间的一致性显着相关（OR 3.30 95% CI 1.25–8.72）。首选死亡地点与实际死亡地点之间的一致性较低，女性是与一致性相关的唯一患者水平变量。
Death in the U.S. frequently occurs in institutions despite the overwhelming majority of persons who state that they prefer to die at home. Little research to date has examined how well individual preferences compare to actual site of death. Determine the concordance between preferred and actual place of death and examine independent predictors for concordance. Observational cohort study. Three area hospitals including a safety net hospital, veterans’ hospital, and academic tertiary referral center. 458 adult patients admitted to the general medical service from 2003–2005. Patients were asked where they preferred to spend their last days of life. Data on date and actual site of death from 2005-2009 was collected from hospital records and death certificates. The majority of patients preferred to die at home (75% n = 343). Low income and being married were significantly associated with a preference to die at home compared to nursing home or inpatient hospice (OR 2.71 95% CI 1.30–5.67 and OR 2.44 95% CI 1.14–5.21 respectively). Of the 123 patients who died during the follow up period, most (66% n = 80) died in an institutional setting. Overall concordance between preferred and actual site of death was only 37% (n = 41). Female gender was significantly associated with concordance between preferred and actual site of death (OR 3.30 95% CI 1.25–8.72). Concordance between preferred and actual site of death is low and female gender was the sole patient level variable associated with concordance.