Sharp L, Foll P, Deady S, O'Ceilleachair A, Buicke C, Carsin A E
National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Rd, Cork.
Ir Med J. 2010 Oct;103(9):262-4, 266.
Investigating trends in where cancer patients die may help inform decisions about how healthcare should be organised to support those in need of end-of-life care. We analysed time trends in place of death for lung cancer during 1994-2005, based on 18,078 death certificates. Time trends were analysed by joinpoint regression. 9,485 (53%) deaths occurred in an acute hospital, 5,239 (29%) at home, 2,178 (12%) in hospices and 728 (4%) in nursing homes. Hospice deaths rose from 7% (108/1539) in 1994 to 15% (234/1560) in 2003, falling slightly in 2004-05. Hospital deaths were unchanged over time, but were more common in areas without hospices. Home deaths decreased significantly (annual percentage change (APC)=-2.2%, 95%CI -3.0% to -1.3%). Nursing home deaths rose significantly (APC=5.7%, 95%CI 2.5% to 8.9%). These trends were not explained by temporal changes in the age-sex distribution of deaths. Despite evidence suggesting most cancer patients would prefer to die at home, and developments in palliative care services, home deaths are declining and most lung cancer deaths occur in hospital.
调查癌症患者的死亡地点趋势，可能有助于为如何组织医疗保健以支持临终关怀患者的决策提供信息。我们基于18,078份死亡证明，分析了1994 - 2005年期间肺癌患者的死亡地点时间趋势。通过连接点回归分析时间趋势。9,485例（53%）死亡发生在急症医院，5,239例（29%）在家中，2,178例（12%）在临终关怀机构，728例（4%）在疗养院。临终关怀机构的死亡比例从1994年的7%（108/1539）升至2003年的15%（234/1560），在2004 - 2005年略有下降。医院死亡比例随时间无变化，但在没有临终关怀机构的地区更为常见。在家中死亡显著减少（年百分比变化（APC）=-2.2%，95%置信区间 -3.0%至 -1.3%）。疗养院死亡显著增加（APC = 5.7%，95%置信区间2.5%至8.9%）。这些趋势无法用死亡年龄 - 性别分布的时间变化来解释。尽管有证据表明大多数癌症患者希望在家中死亡，且姑息治疗服务有所发展，但在家中死亡的人数仍在下降，大多数肺癌患者死于医院。
