Department of Community Health Nursing, Graduate School of Nursing, The Japanese Red Cross University, Tokyo.
Department of Community Health Nursing, Graduate School of Nursing, The Japanese Red Cross University, Tokyo.
Ann Oncol. 2011 Sep;22(9):2113-2120. doi: 10.1093/annonc/mdq719. Epub 2011 Feb 9.
To identify factors influencing place of death among home palliative care patients with advanced cancer, focusing on the timing of referrals from hospital to home care settings.
A cross-sectional nationwide questionnaire survey was conducted on home palliative care patients at 1000 randomly selected home care agencies in Japan. A total of 568 responses were analyzed (effective response rate, 69%).
Multivariate logistic regression analysis revealed that (i) predischarge health care supports in hospital (e.g. early referral 8 days or more before discharge; clear explanation by hospital staffs to patients and families regarding discharge to live and die at home) and (ii) postdischarge health care supports after transferring home care (e.g. signing a 24-h support insurance contract of network between primary physician and nurse as a home palliative care team; primary nurse consultation with primary physician >3 times during the first week after discharge) have an effect on place of death among home palliative care patients.
An early and carefully coordinated referral support system for smooth discharge by hospital staffs as well as intensive and highly qualified support just after discharge by the home care team would help to increase the number of patients who could die at home.
为了确定影响晚期癌症家庭姑息治疗患者死亡地点的因素，本研究重点关注从医院转至家庭护理环境的时间。
在日本，对 1000 家随机选择的家庭护理机构中的家庭姑息治疗患者进行了一项横断面全国性问卷调查。共分析了 568 份回复（有效回复率为 69%）。
多变量逻辑回归分析显示，（i）出院前在医院的医疗支持（例如，在出院前 8 天或更早提前转介；向患者和家属清楚解释出院后在家庭中生活和死亡的情况）和（ii）出院后转至家庭护理后的医疗支持（例如，作为家庭姑息治疗团队，在初级医生和护士之间签署 24 小时支持保险合同网络；出院后第一周内，初级护士与初级医生的咨询次数超过 3 次）对家庭姑息治疗患者的死亡地点有影响。
医院工作人员提前且精心协调的转介支持系统，以及家庭护理团队出院后密集且高素质的支持，将有助于增加在家中死亡的患者数量。
