Chapple Alison, Evans Julie, McPherson Ann, Payne Sheila
Department of Primary Health Care, University of Oxford, Oxford, UK.
BMJ Support Palliat Care. 2011 Dec;1(3):291-5. doi: 10.1136/bmjspcare-2011-000091. Epub 2011 Aug 25.
To explore reasons why people with pancreatic cancer, who are reaching the end of their lives, say they wish to die at home or elsewhere, and why preferences may change.
Qualitative study using semistructured interviews followed by thematic analysis.
Respondents recruited from different parts of the UK during 2009/2010.
16 people with experience of pancreatic cancer (8 patients and 8 bereaved relatives) who discussed place of death in detail during an in-depth interview (from a total sample of 32 people with pancreatic cancer and eight relatives of others who had died of this disease).
People's preferences were affected by their perceptions and previous experiences of care available at home, in a hospice or hospital. Preferences were also shaped by fears about possible loss of dignity, or fears of becoming a burden. Some people thought that a home death might leave bad memories for other members of the family. People with pancreatic cancer and their relatives were aware that preferences might change (or had changed) as death approached.
The National Health Service End of Life Care Strategy for England seeks to meet the needs of people who are dying and promotes better support for home deaths. More information is needed about why patients hold different views about place of care and place of death, why patients' preferences change and what importance patients attach to place of death. Health professionals should bear this in mind if the subject is raised during advance care planning.
探究胰腺癌晚期患者表示希望在家中或其他地方离世的原因，以及偏好可能发生变化的原因。
采用半结构化访谈并进行主题分析的定性研究。
2009/2010年期间从英国不同地区招募的受访者。
16名有胰腺癌经历的人（8名患者和8名丧亲亲属），他们在深入访谈中详细讨论了死亡地点（样本总数为32名胰腺癌患者和8名其他死于该病者的亲属）。
人们的偏好受到他们对家中、临终关怀机构或医院现有护理的认知和既往经历的影响。偏好还受到对可能失去尊严的恐惧或成为负担的恐惧的影响。一些人认为在家中死亡可能会给其他家庭成员留下不好的回忆。胰腺癌患者及其亲属意识到，随着死亡临近，偏好可能会改变（或已经改变）。
英国国家医疗服务体系的英格兰临终关怀战略旨在满足临终患者的需求，并促进对在家中死亡提供更好的支持。需要更多信息来了解患者为何对护理地点和死亡地点持有不同观点、患者偏好为何改变以及患者对死亡地点的重视程度。如果在预先护理计划中提及该主题，卫生专业人员应牢记这一点。
