All authors: King's College London, Cicely Saunders Institute, London, United Kingdom.
J Clin Oncol. 2015 Feb 1;33(4):370-6. doi: 10.1200/JCO.2014.57.3568. Epub 2014 Dec 22.
To explore factors associated with emergency department (ED) attendance by patients with cancer in their last month of life.
Five electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Library) were searched through February 2014 for studies investigating ED attendance toward the end of life by adult patients (age 18 years or older) with cancer. No time or language limitations were applied. We performed meta-analysis of factors using a random-effects model, with results expressed as odds ratios (OR) for ED attendance. Sensitivity analyses explored heterogeneity.
Thirty studies were identified, reporting three demographic, five clinical, and 13 environmental factors, combining data from five countries and 1,181,842 patients. An increased likelihood of ED attendance was found for men (OR, 1.24; 95% CI, 1.19 to 1.29; I(2), 58.2%), black race (OR, 1.45; 95% CI, 1.40 to 1.50; I(2), 0.0%; reference, white race), patients with lung cancer (OR, 1.17; 95% CI, 1.10 to 1.23; I(2), 59.5%; reference, other cancers), and those patients of the lowest socioeconomic status (SES; OR, 1.15; 95% CI, 1.10 to 1.19; I(2), 0.0%; reference, highest SES). Patients receiving palliative care were less likely to attend the ED in their last month of life (OR, 0.43; 95% CI, 0.36 to 0.51; I(2), 59.4%).
We identified demographic (men; black race), clinical (lung cancer), and environmental (low SES; no palliative care) factors associated with an increased risk of ED attendance by patients with cancer in their last month of life. Our findings may be used to develop screening interventions and assist policy-makers to direct resources. Future studies should also investigate previously neglected areas of research, including psychosocial factors, and patients' and caregivers' emergency care preferences.
探讨影响癌症终末期患者急诊就诊的相关因素。
检索 MEDLINE、EMBASE、CINAHL、PsycINFO 和 Cochrane 图书馆等五个电子数据库，检索时间截至 2014 年 2 月，收集研究癌症终末期成人患者（18 岁及以上）急诊就诊的相关文献。不设时间和语言限制。采用随机效应模型对相关因素进行荟萃分析，结果以急诊就诊比值比（OR）表示。敏感性分析用于探索异质性。
共纳入 30 项研究，报道了 3 项人口统计学因素、5 项临床因素和 13 项环境因素，数据来自 5 个国家的 1181842 名患者。研究结果显示，男性（OR，1.24；95% CI，1.19 至 1.29；I(2)，58.2%）、黑种人（OR，1.45；95% CI，1.40 至 1.50；I(2)，0.0%；参照，白种人）、肺癌患者（OR，1.17；95% CI，1.10 至 1.23；I(2)，59.5%；参照，其他癌症）和社会经济地位最低的患者（OR，1.15；95% CI，1.10 至 1.19；I(2)，0.0%；参照，社会经济地位最高的患者）急诊就诊的可能性更高。在生命终末期接受姑息治疗的患者到急诊就诊的可能性较低（OR，0.43；95% CI，0.36 至 0.51；I(2)，59.4%）。
本研究发现，人口统计学因素（男性；黑种人）、临床因素（肺癌）和环境因素（社会经济地位较低；未接受姑息治疗）与癌症终末期患者到急诊就诊的风险增加相关。研究结果或可用于开发筛查干预措施，并协助决策者合理分配资源。未来的研究还应关注包括心理社会因素在内的此前被忽视的研究领域，以及患者和护理人员对急诊治疗的偏好。
