Brazil Kevin, Howell Doris, Bedard Michel, Krueger Paul, Heidebrecht Christine
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Palliat Med. 2005 Sep;19(6):492-9. doi: 10.1191/0269216305pm1050oa.
(1) To determine informal caregivers perceptions about place of care and place of death; and (2) to identify variables associated with a home death among terminally ill individuals who received in-home support services in a publicly funded home care system.
A total of 216 informal caregivers participated in a bereavement interview. Data collection included care recipient and informal caregiver characteristics, the use of and satisfaction with community services, and preferences about place of death.
Most caregivers reported that they and the care recipient had a preferred place of death (77 and 68%, respectively) with over 63% reporting home as the preferred place of death. Caregivers had a greater preference for an institutional death (14%) than care recipients (4.7%). While 30% of care recipients did not die in their preferred location, most caregivers (92%) felt, in retrospect, that where the care recipient died was the appropriate place of death. Most caregivers reported being satisfied with the care that was provided. The odds of dying at home were greater when the care recipient stated a preference for place of death (OR: 2.92; 95% CI: 1.25, 6.85), and the family physician made home visits during the care recipients last month of life (Univariate odds ratios (OR): 4.42; 95% CI: 1.46, 13.36).
The ethic of self-control and choice for the care recipient must be balanced with consideration for the well being of the informal caregiver and responsiveness of the community service system.
（1）确定非正式照料者对照料地点和死亡地点的看法；（2）识别在公共资助的家庭护理系统中接受居家支持服务的绝症患者中与在家中死亡相关的变量。
共有216名非正式照料者参与了丧亲访谈。数据收集包括受照料者和非正式照料者的特征、对社区服务的使用情况和满意度，以及对死亡地点的偏好。
大多数照料者报告称他们和受照料者都有一个首选的死亡地点（分别为77%和68%），超过63%的人报告首选在家中死亡。与受照料者（4.7%）相比，照料者更倾向于机构死亡（14%）。虽然30%的受照料者并非在其首选地点死亡，但大多数照料者（92%）事后认为受照料者死亡的地点就是合适的死亡地点。大多数照料者报告对所提供的照料感到满意。当受照料者表明对死亡地点有偏好时，在家中死亡的几率更高（比值比：2.92；95%置信区间：1.25，6.85），并且家庭医生在受照料者生命的最后一个月进行了家访（单变量比值比：4.42；95%置信区间：1.46，13.36）。
对照料接受者的自我控制和选择伦理必须与对照料者福祉的考虑以及社区服务系统的响应能力相平衡。
