Tang Siew Tzuh, Mccorkle Ruth
National Yang-Ming University, School of Nursing, Taipei, Taiwan.
J Palliat Care. 2003 Winter;19(4):230-7.
A prospective cohort study was conducted to explore the extent of congruence and to identify the determinants of congruence between the preferred and actual place of death of terminally ill cancer patients. A total of 180 terminally ill cancer patients were enrolled (87% response rate) and 127 died during the one-year study period. Nearly 90% of the subjects preferred to die at home. One-third achieved their preference for place of death. The kappa value of congruence (kappa = 0.11, 95% confidence interval = 0.05-0.17) indicated poor to slight agreement between the preferred and actual place death. Important determinants of congruence between the preferred and actual place of death for terminally ill cancer patients included rehospitalisation and receiving hospice home care during the final days of life, perceived ability for family to help achieve preferred place of death, and residence in New Haven County.
This study directly confirms that the degree of congruence between the preferred and actual place death is unsatisfactory. Clinical interventions and health policies need to be developed to assist terminally ill cancer patients who may not be able to achieve their preference for place of end-of-life care and death.
进行了一项前瞻性队列研究，以探讨一致性程度，并确定晚期癌症患者首选死亡地点与实际死亡地点之间一致性的决定因素。总共招募了180名晚期癌症患者（应答率为87%），在为期一年的研究期间，127人死亡。近90%的受试者希望在家中死亡。三分之一的人实现了他们对死亡地点的偏好。一致性的kappa值（kappa = 0.11，95%置信区间 = 0.05 - 0.17）表明首选死亡地点与实际死亡地点之间的一致性较差到一般。晚期癌症患者首选死亡地点与实际死亡地点之间一致性的重要决定因素包括再次住院、在生命最后几天接受临终家庭护理、认为家人有能力帮助实现首选死亡地点以及居住在纽黑文县。
本研究直接证实，首选死亡地点与实际死亡地点之间的一致性程度并不理想。需要制定临床干预措施和卫生政策，以帮助那些可能无法实现其对临终护理和死亡地点偏好的晚期癌症患者。
