Hurley Susan Lysaght, Colling Caitlin, Bender Laura, Harris Pamela S, Harrold Joan K, Teno Joan M, Ache Kevin A, Casarett David
North Shore Medical Center, Salem, Massachusetts, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
BMJ Support Palliat Care. 2017 Mar;7(1):46-52. doi: 10.1136/bmjspcare-2013-000599. Epub 2014 Nov 13.
Growth in hospice utilisation has been accompanied by an increase in the proportion of hospice patients who die in an inpatient hospice setting rather than at home.
To determine whether this increase in inpatient utilisation is consistent with patient preferences.
Retrospective cohort study.
Seven hospices in the Coalition of Hospices Organised to Investigate Comparative Effectiveness (CHOICE) network.
70 488 patients admitted between 1 July 2008 and 31 May 2012.
We measured changes in patients' stated preferences at the time of admission regarding site of death, including weights to adjust for non-response bias. We also assessed patients' actual site of death and concordance with patients' preferences.
More patients died receiving inpatient care in 2012 as compared to 2008 (1920 (32.7%), 2537 (18.5%); OR 1.21; 95% CI 1.19 to 1.22; p<0.001). However, patients also expressed an increasing preference for dying in inpatient settings (weighted preferences 27.5% in 2012 vs 7.9% in 2008; p<0.001). The overall proportion of patients who died in the setting of their choice (weighted preferences) increased from 74% in 2008 to 78% in 2012 (p<0.001).
This study included only seven hospices, and results may not be representative of the larger hospice population.
Although more patients are dying while receiving inpatient care, these changes in site of death seem to reflect changing patient preferences. The net effect is that patients in this sample were more likely to die in the setting of their choice in 2012 than they were in 2008.
临终关怀机构利用率的增长伴随着在临终关怀机构住院死亡而非在家中死亡的临终关怀患者比例的增加。
确定住院利用率的这种增长是否与患者偏好一致。
回顾性队列研究。
组织起来调查比较效果的临终关怀联盟(CHOICE)网络中的七家临终关怀机构。
2008年7月1日至2012年5月31日期间收治的70488名患者。
我们测量了患者入院时关于死亡地点的明确偏好的变化,包括用于调整无应答偏差的权重。我们还评估了患者的实际死亡地点以及与患者偏好的一致性。
与2008年相比,2012年接受住院治疗死亡的患者更多(1920例(32.7%),2537例(18.5%);比值比1.21;95%置信区间1.19至1.22;p<0.001)。然而,患者对在住院环境中死亡的偏好也在增加(2012年加权偏好为27.5%,2008年为7.9%;p<0.001)。在其选择的环境中死亡的患者总体比例(加权偏好)从2008年的74%增加到2012年的78%(p<0.001)。
本研究仅包括七家临终关怀机构,结果可能不代表更大的临终关怀人群。
尽管有更多患者在接受住院治疗时死亡,但死亡地点的这些变化似乎反映了患者偏好的改变。净效应是,该样本中的患者在2012年比2008年更有可能在其选择的环境中死亡。