Division of General Internal Medicine, University of Colorado Denver School of Medicine, Denver, Colorado 80045, USA.
J Hosp Med. 2013 Apr;8(4):178-83. doi: 10.1002/jhm.2018. Epub 2013 Feb 25.
Death in the U.S. frequently occurs in institutions despite the overwhelming majority of persons who state that they prefer to die at home. Little research to date has examined how well individual preferences compare to actual site of death.
Determine the concordance between preferred and actual place of death and examine independent predictors for concordance.
Observational cohort study.
Three area hospitals including a safety net hospital, veterans' hospital, and academic tertiary referral center.
458 adult patients admitted to the general medical service from 2003-2005.
Patients were asked where they preferred to spend their last days of life. Data on date and actual site of death from 2005-2009 was collected from hospital records and death certificates.
The majority of patients preferred to die at home (75% n = 343). Low income and being married were significantly associated with a preference to die at home compared to nursing home or inpatient hospice (OR 2.71 95% CI 1.30-5.67 and OR 2.44 95% CI 1.14-5.21 respectively). Of the 123 patients who died during the follow up period, most (66% n = 80) died in an institutional setting. Overall concordance between preferred and actual site of death was only 37% (n = 41). Female gender was significantly associated with concordance between preferred and actual site of death (OR 3.30 95% CI 1.25-8.72).
Concordance between preferred and actual site of death is low and female gender was the sole patient level variable associated with concordance.
尽管绝大多数人表示他们更愿意在家中去世，但美国的死亡事件仍经常发生在医疗机构中。迄今为止，很少有研究探讨个人偏好与实际死亡地点之间的吻合程度。
确定偏好的死亡地点与实际死亡地点之间的一致性，并研究一致性的独立预测因素。
观察性队列研究。
包括一家保障医院、退伍军人医院和学术三级转诊中心在内的三家地区医院。
2003 年至 2005 年期间入住普通医疗服务的 458 名成年患者。
询问患者他们希望在哪里度过生命的最后几天。从 2005 年至 2009 年，从医院记录和死亡证明中收集有关死亡日期和实际地点的数据。
大多数患者更愿意在家中去世（75%，n=343）。与疗养院或住院临终关怀相比，低收入和已婚状态与在家中去世的偏好显著相关（OR 2.71，95%CI 1.30-5.67 和 OR 2.44，95%CI 1.14-5.21）。在随访期间死亡的 123 名患者中，大多数（66%，n=80）在机构环境中去世。偏好和实际死亡地点之间的总体一致性仅为 37%（n=41）。女性性别与偏好和实际死亡地点之间的一致性显著相关（OR 3.30，95%CI 1.25-8.72）。
偏好和实际死亡地点之间的一致性较低，女性性别是唯一与一致性相关的患者个体变量。
