Murtagh Fliss E M, Bausewein Claudia, Verne Julia, Groeneveld E Iris, Kaloki Yvonne E, Higginson Irene J
1King's College London, Cicely Saunders Institute, London, UK.
Palliat Med. 2014 Jan;28(1):49-58. doi: 10.1177/0269216313489367. Epub 2013 May 21.
Understanding the need for palliative care is essential in planning services.
To refine existing methods of estimating population-based need for palliative care and to compare these methods to better inform their use.
(1) Refinement of existing population-based methods, based on the views of an expert panel, and (2) application/comparison of existing and refined approaches in an example dataset. Existing methods vary in approach and in data sources. (a) Higginson used cause of death/symptom prevalence, and using pain prevalence, estimates that 60.28% (95% confidence interval = 60.20%-60.36%) of all deaths need palliative care, (b) Rosenwax used the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) causes of death/hospital-use data, and estimates that 37.01% (95% confidence interval = 36.94%-37.07%) to 96.61% (95% confidence interval = 96.58%-96.64%) of deaths need palliative care, and (c) Gómez-Batiste used percentage of deaths plus chronic disease data, and estimates that 75% of deaths need palliative care.
SETTING/PARTICIPANTS: All deaths in England, January 2006-December 2008, using linked mortality and hospital episode data.
Expert panel review identified changing practice (e.g. extension of palliative care to more non-cancer conditions), changing patterns of hospital/home care and multiple, rather than single, causes of death as important. We therefore refined methods (using updated ICD-10 causes of death, underlying/contributory causes, and hospital use) to estimate a minimum of 63.03% (95% confidence interval = 62.95%-63.11%) of all deaths needing palliative care, with lower and upper mid-range estimates between 69.10% (95% confidence interval = 69.02%-69.17%) and 81.87% (95% confidence interval = 81.81%-81.93%).
Death registration data using both underlying and contributory causes can give reliable estimates of the population-based need for palliative care, without needing symptom or hospital activity data. In high-income countries, 69%-82% of those who die need palliative care.
了解姑息治疗需求对于规划服务至关重要。
完善现有的基于人群的姑息治疗需求评估方法，并对这些方法进行比较，以便更好地指导其应用。
（1）根据专家小组的意见完善现有的基于人群的方法，（2）在一个示例数据集中应用/比较现有方法和完善后的方法。现有方法在方法和数据来源上各不相同。（a）希金森使用死因/症状患病率，并根据疼痛患病率估计，所有死亡中有60.28%（95%置信区间=60.20%-60.36%）需要姑息治疗，（b）罗森瓦克斯使用国际疾病分类及相关健康问题第十次修订版（ICD-10）死因/医院使用数据，估计37.01%（95%置信区间=36.94%-37.07%）至96.61%（95%置信区间=96.58%-96.64%）的死亡需要姑息治疗，（c）戈麦斯-巴蒂斯特使用死亡百分比加慢性病数据，估计75%的死亡需要姑息治疗。
背景/参与者：利用2006年1月至2008年12月英格兰的所有死亡数据，结合死亡率和医院诊疗数据。
专家小组审查确定，实践的变化（如将姑息治疗扩展到更多非癌症疾病）、医院/家庭护理模式的变化以及多种而非单一的死因很重要。因此，我们完善了方法（使用更新后的ICD-10死因、根本/促成死因和医院使用情况），以估计至少63.03%（95%置信区间=62.95%-63.11%）的死亡需要姑息治疗，中值较低和较高的估计值分别在69.10%（95%置信区间=69.02%-69.17%）和81.87%（95%置信区间=81.81%-81.93%）之间。
使用根本死因和促成死因的死亡登记数据可以可靠地估计基于人群的姑息治疗需求，而无需症状或医院活动数据。在高收入国家，69%-82%的死者需要姑息治疗。
