Jordhøy M S, Fayers P, Saltnes T, Ahlner-Elmqvist M, Jannert M, Kaasa S
Unit of Applied Clinical Research, Norwegian University of Science and Technology, Kreftbygget, University Hospital of Trondheim.
Lancet. 2000 Sep 9;356(9233):888-93. doi: 10.1016/s0140-6736(00)02678-7.
The Palliative Medicine Unit at University Hospital of Trondheim, Norway, started an intervention programme that aims to enable patients to spend more time at home and die there if they prefer. Close cooperation was needed with the community health-care professionals, who acted as the principal formal caregivers, and a multidisciplinary consultant team coordinated the care. We did a cluster randomised trial to assess the intervention's effectiveness compared with conventional care
Community health-care districts in and around Trondheim, Norway, were defined as the clusters to be randomised. We enrolled 434 patients (235 assigned intervention and 199 conventional care [controls]) in these districts who had incurable malignant disease and an expected survival of 2-9 months. Main outcomes were place of death and time spent in institutions in the last month of life.
395 patients died. Of these, more intervention patients than controls died at home (54 [25%] vs 26 [15%], p<0.05). The time spent at home was not significantly increased, although intervention patients spent a smaller proportion of time in nursing homes in the last month of life than did controls (7.2 vs 14.6%, p<0.05). Hospital use was similar in the two groups.
The palliative-care intervention enabled more patients to die at home. More resources for care in the home (palliative care training and staff) and an increased focus on use of nursing homes would be necessary, however, to increase time at home and reduce hospital admissions.
挪威特隆赫姆大学医院的姑息治疗科启动了一项干预项目，旨在让患者如果愿意的话，能有更多时间在家中度过并在家中离世。这需要与作为主要正式照护者的社区医疗保健专业人员密切合作，并且一个多学科顾问团队协调护理工作。我们进行了一项整群随机试验，以评估该干预措施与传统护理相比的效果。
将挪威特隆赫姆及其周边的社区医疗保健区定义为要进行随机分组的群组。我们在这些地区纳入了434例患有无法治愈的恶性疾病且预期生存期为2至9个月的患者（235例被分配接受干预，199例接受传统护理[对照]）。主要结局指标为死亡地点以及生命最后一个月在医疗机构度过的时间。
395例患者死亡。其中，干预组在家中死亡的患者比对照组多（54例[25%]对26例[15%]，p<0.05）。在家中度过的时间没有显著增加，尽管干预组患者在生命最后一个月在养老院度过的时间比例低于对照组（7.2%对14.6%，p<0.05）。两组的医院使用率相似。
姑息治疗干预措施使更多患者能够在家中死亡。然而，要增加在家中的时间并减少住院次数，需要为家庭护理提供更多资源（姑息治疗培训和工作人员），并更加关注养老院的使用情况。
