Neergaard Mette Asbjoern, Jensen Anders Bonde, Sondergaard Jens, Sokolowski Ineta, Olesen Frede, Vedsted Peter
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Scand J Caring Sci. 2011 Dec;25(4):627-36. doi: 10.1111/j.1471-6712.2011.00870.x. Epub 2011 Mar 1.
Achieving home death is often seen as an important endpoint in palliative care, but no studies of the preferred place-of-death have yet been conducted in Scandinavia. Furthermore, we do not know if professionals' report on deceased patients' preference of place-of-death is a valid information. The aim of this study was to describe where terminally ill Danish cancer patients prefer to die and to determine if their preference changed during the palliative period, as reported retrospectively by bereaved relatives, general practitioners (GPs) and community nurses (CNs) and to assess the agreement of their accounts. The study was a population-based, cross-sectional combined register and questionnaire study in Aarhus County, Denmark. The population comprised 599 deceased adult cancer patients who had died from 1 March to 30 November 2006 and were identified through merging of health registers. Relatives returned 198 questionnaires about patients' preferred place-of-death, GPs 333 and CNs 201. The study showed that most terminally ill cancer patients preferred home death (up to 80.7%). The reported preference for home death weakened as death approached (down to 64.4%). A better congruence was seen between relatives' and GPs' accounts of preference for place of death at the end of the palliative period (κ 0.71) than between relatives' and CNs' accounts (κ 0.37). In conclusion, bereaved relatives (and GPs and CNs) report retrospectively that most terminally ill cancer patients wish to die at home. The preference weakened significantly as death approached. The agreement between relatives' and GPs' accounts on patients' preferences at the end of the palliative period was 'substantial', whereas the agreement between relatives' and CNs' accounts at the same time was significantly less outspoken. This indicates that CNs may be facing a problem in assessing their patients' wishes retrospectively.
在家中离世通常被视为姑息治疗的一个重要终点，但斯堪的纳维亚地区尚未开展关于首选死亡地点的研究。此外，我们并不清楚专业人员所报告的已故患者对死亡地点的偏好是否为有效信息。本研究的目的是描述丹麦晚期癌症患者希望在何处离世，并确定在姑息治疗期间他们的偏好是否发生变化，这是由丧亲亲属、全科医生（GPs）和社区护士（CNs）进行回顾性报告的，并评估他们陈述的一致性。该研究是丹麦奥胡斯郡一项基于人群的横断面联合登记和问卷调查研究。研究对象包括599名成年癌症死亡患者，他们于2006年3月1日至11月30日期间死亡，通过合并健康登记册得以确定。亲属返回了198份关于患者首选死亡地点的问卷，全科医生返回了333份，社区护士返回了201份。研究表明，大多数晚期癌症患者更倾向于在家中离世（高达80.7%）。随着死亡临近，报告的在家中离世的偏好有所减弱（降至64.4%）。在姑息治疗期结束时，亲属和全科医生关于死亡地点偏好的陈述之间的一致性（κ值为0.71）高于亲属和社区护士之间的一致性（κ值为0.37）。总之，丧亲亲属（以及全科医生和社区护士）回顾性报告称，大多数晚期癌症患者希望在家中离世。随着死亡临近，这种偏好显著减弱。在姑息治疗期结束时，亲属和全科医生关于患者偏好的陈述之间的一致性“较高”，而此时亲属和社区护士之间的一致性则明显较低。这表明社区护士在回顾性评估患者意愿时可能面临问题。
