Department of Urology, University of California at Los Angeles, Los Angeles, California 90095-1738, USA.
Cancer. 2010 May 1;116(9):2126-31. doi: 10.1002/cncr.25039.
The quality of end-of-life care was assessed in disadvantaged men prospectively enrolled in a public assistance program. That end-of-life care would be aggressive, more so than recommended by quality-of-care guidelines, was hypothesized.
Included in the study were all 60 low-income, uninsured men in a state-funded public assistance program who had died since its inception in 2001. To measure quality of end-of-life care, information was collected regarding timing of the institution of new chemotherapeutic regimens, time from administration of last chemotherapy dose to death, the number of inpatient admissions and intensive care unit stays made in the 3 months preceding death, and the number of emergency room visits made in the 12 months before dying. Also noted were hospice use and the timing of hospice referrals.
Eighteen men (30%) enrolled in hospice before death and the average hospice stay lasted 45 days (standard deviation, 32; range, 2-143 days; median, 41 days). Two patients (11%) were enrolled for fewer than 7 days, and none were enrolled for more than 180 days. The average time from administration of the last dose of chemotherapy to death was 104 days. Chemotherapy was never initiated within 3 months of death, and in only 2 instances (6%) was the final chemotherapeutic regimen administered within 2 weeks of dying. Use of hospital resources (emergency room visits, inpatient admissions, and intensive care unit stays) was uniformly low (mean, 1.0 +/- 1.0, 0.65 +/- 0.82, and 0.03 +/- 0.18, respectively).
End-of-life care in disadvantaged men dying of prostate cancer, who enroll in a comprehensive statewide assistance program, is high-quality.
本研究前瞻性地评估了纳入公共援助项目的弱势男性临终关怀质量。假设临终关怀会更具侵略性，超过推荐的护理质量指南。
本研究纳入了自 2001 年启动以来所有在州资助的公共援助计划中死亡的 60 名低收入、无保险的男性。为了衡量临终关怀质量，收集了有关新化疗方案开始时间、末次化疗剂量至死亡时间、死亡前 3 个月内住院和重症监护病房入住次数、以及死前 12 个月内急诊就诊次数的信息。还记录了临终关怀的使用情况和临终关怀转介的时间。
18 名男性（30%）在死亡前加入了临终关怀，平均临终关怀持续时间为 45 天（标准差为 32；范围为 2-143 天；中位数为 41 天）。2 名患者（11%）入组时间少于 7 天，没有患者入组时间超过 180 天。从末次化疗剂量到死亡的平均时间为 104 天。化疗从未在死亡前 3 个月内开始，只有 2 例（6%）在死亡前 2 周内给予了最后一次化疗方案。医院资源的使用（急诊就诊、住院和重症监护病房入住）均较低（平均值分别为 1.0 +/- 1.0、0.65 +/- 0.82 和 0.03 +/- 0.18）。
在参加全面全州援助计划的贫困男性中，前列腺癌死亡患者的临终关怀质量较高。
