Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
J Clin Oncol. 2015 Feb 1;33(4):357-63. doi: 10.1200/JCO.2014.55.7355. Epub 2014 Dec 22.
To explore the associations between place of death and quality of death and dying and caregiver burden in terminally ill patients with cancer and their families.
Two bereavement surveys were conducted in October 2008 and October 2011. A total of 2,247 family caregivers of patients with cancer who were deceased responded to the mail surveys (response rate, 67%). Family members reported patient quality of death and dying and caregiver burden by using the Good Death Inventory and Caregiving Consequences Inventory.
Patient quality of death and dying was significantly higher at home relative to other places of dying after adjustment for patient and/or family characteristics (adjusted means): 5.0 (95% CI, 4.9 to 5.2) for home, 4.6 (95% CI, 4.5 to 4.7) for palliative care units, and 4.3 (95% CI, 4.2 to 4.4) for hospitals. For all combinations, pairwise P < .001; the size of the difference between home and hospital was moderate (Hedges' g, 0.45). Home was superior to palliative care units or hospitals with respect to "dying in a favorite place," "good relationships with medical staff," "good relationships with family," and "maintaining hope and pleasure" (P < .001 for all combinations of home v palliative care units and home v hospitals). Home death was significantly associated with a lower overall (P = .03) and financial caregiver burden (P = .004) relative to hospital death.
Dying at home may contribute to achieving good death in terminally ill patients with cancer without causing remarkably increased caregiver burden. Place of death should be regarded as an essential goal in end-of-life care.
探讨癌症终末期患者及其家属的死亡地点与死亡质量和临终关怀负担之间的关系。
在 2008 年 10 月和 2011 年 10 月进行了两次丧亲调查。共有 2247 名癌症患者的家庭照顾者通过邮件调查做出回应（回应率为 67%）。家庭成员使用《美好死亡清单》和《照顾后果清单》报告患者的死亡质量和临终关怀负担。
调整患者和/或家庭特征后，与其他死亡地点相比，在家中患者的死亡质量和临终关怀负担明显更高（调整后平均值）：在家中为 5.0（95%CI，4.9 至 5.2），在姑息治疗病房为 4.6（95%CI，4.5 至 4.7），在医院为 4.3（95%CI，4.2 至 4.4）。对于所有组合，两两比较 P<.001；在家中与医院之间的差异大小为中等（Hedges'g，0.45）。在家中与姑息治疗病房或医院相比，在“在喜爱的地方去世”、“与医务人员关系良好”、“与家人关系良好”和“保持希望和愉悦”方面具有优势（在家中与姑息治疗病房和在家中与医院的所有组合比较中 P<.001）。与医院死亡相比，在家中死亡与整体（P=0.03）和经济方面的 caregiver 负担（P=0.004）显著降低相关。
对于癌症终末期患者，在家中死亡可能有助于实现美好死亡，而不会显著增加 caregiver 负担。死亡地点应被视为临终关怀的一个重要目标。
