Waghorn Melanie, Young Holly, Davies Andrew
Palliative Care, St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
BMJ Support Palliat Care. 2011 Dec;1(3):310-4. doi: 10.1136/bmjspcare-2011-000041. Epub 2011 Aug 25.
The primary objective of the study was to determine the relative importance of place of death to patients with advanced cancer being treated at a cancer centre in England.
Demographic data were collected from the electronic patient record system, with additional information obtained from the patients themselves. Patients were questioned about a variety of end of life issues, including preferred place of death (PPD), and 'acceptable' places of death. They were also asked to rank the importance of factors previously linked to a 'good death'.
120 patients participated in the study. 51 (42.5%) patients stated that 'home' was their PPD, while 80 (67%) patients stated that home was an acceptable place of death. Patients from areas with worse deprivation scores were less likely to want to die at home than patients from areas with better deprivation scores (p=0.03). The most important factors associated with a good death were 'to have my pain/symptoms well controlled', 'to not be a burden to my family' and 'to have sorted out my personal affairs' respectively. Place of death was ranked as the seventh most important factor.
Place of death is undoubtedly an important factor in achieving a good death for some patients and carers. However, for others a home death is either unimportant or to be avoided. The results of this study, and the results of similar studies, suggest that place of death may not be a good marker of the quality of end of life care.
本研究的主要目的是确定在英格兰一家癌症中心接受治疗的晚期癌症患者中，死亡地点的相对重要性。
从电子病历系统收集人口统计学数据，并从患者本人处获取额外信息。询问患者各种临终问题，包括首选死亡地点（PPD）和“可接受”的死亡地点。还要求他们对先前与“善终”相关的因素的重要性进行排序。
120名患者参与了研究。51名（42.5%）患者表示“家中”是他们的首选死亡地点，而80名（67%）患者表示家中是可接受的死亡地点。贫困得分较差地区的患者比贫困得分较好地区的患者更不愿意在家中死亡（p=0.03）。与善终相关的最重要因素分别是“疼痛/症状得到良好控制”、“不给家人造成负担”和“处理好个人事务”。死亡地点被列为第七重要因素。
对于一些患者和护理人员来说，死亡地点无疑是实现善终的一个重要因素。然而，对另一些人来说，在家中死亡要么不重要，要么应避免。本研究的结果以及类似研究的结果表明，死亡地点可能不是临终护理质量的良好指标。
