Pivodic Lara, Harding Richard, Calanzani Natalia, McCrone Paul, Hall Sue, Deliens Luc, Higginson Irene J, Gomes Barbara
Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
Palliat Med. 2016 Jan;30(1):64-74. doi: 10.1177/0269216315589213. Epub 2015 Jun 2.
Stronger generalist end-of-life care at home for people with cancer is called for but the quality of end-of-life care delivered by general practitioners has been questioned.
To determine the degree of and factors associated with bereaved relatives' satisfaction with home end-of-life care delivered by general practitioners to cancer patients.
Population-based mortality followback survey.
SETTING/PARTICIPANTS: Bereaved relatives of people who died of cancer in London, United Kingdom (identified from death registrations in 2009-2010), were invited to complete a postal questionnaire surveying the deceased's final 3 months of life.
Questionnaires were completed for 596 decedents of whom 548 spent at least 1 day at home in the last 3 months of life. Of the respondents, 55% (95% confidence interval: 51%-59%) reported excellent/very good home care by general practitioners, compared with 78% (95% confidence interval: 74%-82%) for specialist palliative care providers and 68% (95% confidence interval: 64%-73%) for district/community/private nurses. The odds of high satisfaction (excellent/very good) with end-of-life care by general practitioners doubled if general practitioners made three or more compared with one or no home visits in the patient's last 3 months of life (adjusted odds ratio: 2.54 (95% confidence interval: 1.52-4.24)) and halved if the patient died at hospital rather than at home (adjusted odds ratio: 0.55 (95% confidence interval: 0.31-0.998)).
There is considerable room for improvement in the satisfaction with home care provided by general practitioners to terminally ill cancer patients. Ensuring an adequate offer of home visits by general practitioners may help to achieve this goal.
人们呼吁为癌症患者在家中提供更强有力的全科临终关怀服务，但全科医生提供的临终关怀服务质量受到了质疑。
确定癌症患者临终时全科医生提供的居家临终关怀服务，丧亲亲属的满意度程度及相关因素。
基于人群的死亡率随访调查。
地点/参与者：邀请了在英国伦敦死于癌症的患者的丧亲亲属（从2009 - 2010年的死亡登记中识别），完成一份邮寄问卷调查，调查死者生命的最后3个月情况。
为596名死者完成了问卷，其中548人在生命的最后3个月至少在家中度过了1天。在受访者中，55%（95%置信区间：51% - 59%）报告全科医生提供了优秀/非常好的居家护理，相比之下，专科姑息治疗提供者为78%（95%置信区间：74% - 82%），地区/社区/私人护士为68%（95%置信区间：64% - 73%）。如果全科医生在患者生命的最后3个月进行了三次或更多次家访，与进行一次或没有家访相比，对全科医生临终关怀服务高度满意（优秀/非常好）的几率翻倍（调整后的优势比：2.54（95%置信区间：1.52 - 4.24））；如果患者在医院而非家中死亡，满意度几率减半（调整后的优势比：0.55（95%置信区间：0.31 - 0.998））。
全科医生为晚期癌症患者提供的居家护理满意度有很大的提升空间。确保全科医生提供足够的家访可能有助于实现这一目标。
