死亡地点的决定因素：基于证据的分析
The Determinants of Place of Death: An Evidence-Based Analysis.
作者信息
Costa V
出版信息
Ont Health Technol Assess Ser. 2014 Dec 1;14(16):1-78. eCollection 2014.
BACKGROUND
According to a conceptual model described in this analysis, place of death is determined by an interplay of factors associated with the illness, the individual, and the environment.
OBJECTIVES
Our objective was to evaluate the determinants of place of death for adult patients who have been diagnosed with an advanced, life-limiting condition and are not expected to stabilize or improve.
DATA SOURCES
A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2004, to September 24, 2013.
REVIEW METHODS
Different places of death are considered in this analysis-home, nursing home, inpatient hospice, and inpatient palliative care unit, compared with hospital. We selected factors to evaluate from a list of possible predictors-i.e., determinants-of death. We extracted the adjusted odds ratios and 95% confidence intervals of each determinant, performed a meta-analysis if appropriate, and conducted a stratified analysis if substantial heterogeneity was observed.
RESULTS
From a literature search yielding 5,899 citations, we included 2 systematic reviews and 29 observational studies. Factors that increased the likelihood of home death included multidisciplinary home palliative care, patient preference, having an informal caregiver, and the caregiver's ability to cope. Factors increasing the likelihood of a nursing home death included the availability of palliative care in the nursing home and the existence of advance directives. A cancer diagnosis and the involvement of home care services increased the likelihood of dying in an inpatient palliative care unit. A cancer diagnosis and a longer time between referral to palliative care and death increased the likelihood of inpatient hospice death. The quality of the evidence was considered low.
LIMITATIONS
Our results are based on those of retrospective observational studies.
CONCLUSIONS
The results obtained were consistent with previously published systematic reviews. The analysis identified several factors that are associated with place of death.
背景
根据本分析中描述的概念模型，死亡地点由与疾病、个体和环境相关的因素相互作用决定。
目的
我们的目的是评估已被诊断患有晚期、危及生命疾病且预计病情不会稳定或改善的成年患者死亡地点的决定因素。
数据来源
使用Ovid MEDLINE、Ovid MEDLINE在研及其他未索引引文、Ovid Embase、EBSCO护理及相关健康文献累积索引（CINAHL）和循证医学综述，对2004年1月1日至2013年9月24日发表的研究进行文献检索。
综述方法
本分析考虑了不同的死亡地点——家庭、养老院、住院临终关怀机构和住院姑息治疗病房，并与医院进行比较。我们从可能的预测因素列表（即死亡决定因素）中选择要评估的因素。我们提取了每个决定因素的调整后比值比和95%置信区间，酌情进行荟萃分析，若观察到显著异质性则进行分层分析。
结果
通过文献检索获得5899条引文，我们纳入了2篇系统评价和29项观察性研究。增加在家中死亡可能性的因素包括多学科家庭姑息治疗、患者偏好、有非正式照护者以及照护者的应对能力。增加在养老院死亡可能性的因素包括养老院提供姑息治疗以及存在预立医疗指示。癌症诊断和家庭护理服务的参与增加了在住院姑息治疗病房死亡的可能性。癌症诊断以及从转诊至姑息治疗到死亡之间的时间较长增加了在住院临终关怀机构死亡的可能性。证据质量被认为较低。
局限性
我们的结果基于回顾性观察性研究。
结论
获得的结果与先前发表的系统评价一致。该分析确定了几个与死亡地点相关的因素。
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