一项基于人群的回顾性队列研究：关于生命最后一年获得专科姑息治疗的情况——十年过去了，谁仍未得到治疗？
A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on?
作者信息
Rosenwax Lorna, Spilsbury Katrina, McNamara Beverley A, Semmens James B
机构信息
School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, 6845, Australia.
Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Australia.
出版信息
BMC Palliat Care. 2016 May 10;15:46. doi: 10.1186/s12904-016-0119-2.
BACKGROUND
Historically, specialist palliative care has been accessed by a greater proportion of people dying with cancer compared to people with other life-limiting conditions. More recently, a variety of measures to improve access to palliative care for people dying from non-cancer conditions have been implemented. There are few rigorous population-based studies that document changes in palliative care service delivery relative to the number of patients who could benefit from such services.
METHOD
A retrospective cohort study of the last year of life of persons with an underlying cause of death in 2009-10 from cancer, heart failure, renal failure, liver failure, chronic obstructive pulmonary disease, Alzheimer's disease, motor neurone disease, Parkinson's disease, Huntington's disease and/or HIV/AIDS. The proportion of decedents receiving specialist palliative care was compared to a 2000-02 cohort. Logistic regression models were used identify social and demographic factors associated with accessing specialist palliative care.
RESULTS
There were 12,817 deaths included into the cohort; 7166 (56 %) from cancer, 527 (4 %) from both cancer and non-cancer conditions and 5124 (40 %) from non-cancer conditions. Overall, 46.3 % of decedents received community and/or hospital based specialist palliative care; a 3.5 % (95 % CI 2.3-4.7) increase on specialist palliative care access reported ten years earlier. The majority (69 %; n = 4928) of decedents with cancer accessed palliative care during the last year of life. Only 14 % (n = 729) of decedents with non-cancer conditions accessed specialist palliative care, however, this represented a 6.1 % (95 % CI 4.9-7.3) increase on the specialist palliative care access reported for the same decedent group ten years earlier. Compared to decedents with heart failure, increased odds of palliative care access was observed for decedents with cancer (OR 10.5; 95 % CI 9.1-12.2), renal failure (OR 1.5; 95 % CI 1.3-1.9), liver failure (OR 2.3; 95 % CI 1.7-3.3) or motor neurone disease (OR 4.5; 95 % CI 3.1-6.6). Living in major cities, being female, having a partner and living in a private residence was associated with increased odds of access to specialist palliative care.
CONCLUSION
There is small but significant increase in access to specialist palliative care services in Western Australia, specifically in patients dying with non-cancer conditions.
背景
从历史上看，与患有其他生命受限疾病的人相比，死于癌症的人中接受专科姑息治疗的比例更高。最近，已经实施了各种措施来改善非癌症疾病患者获得姑息治疗的机会。很少有基于人群的严格研究记录姑息治疗服务提供相对于可从此类服务中受益的患者数量的变化。
方法
对2009 - 10年因癌症、心力衰竭、肾衰竭、肝衰竭、慢性阻塞性肺疾病、阿尔茨海默病、运动神经元病、帕金森病、亨廷顿病和/或艾滋病毒/艾滋病等潜在死因的人的生命最后一年进行回顾性队列研究。将接受专科姑息治疗的死者比例与2000 - 02年的队列进行比较。使用逻辑回归模型确定与获得专科姑息治疗相关的社会和人口因素。
结果
该队列纳入了12817例死亡病例；7166例（56%）死于癌症，527例（4%）死于癌症和非癌症疾病，5124例（40%）死于非癌症疾病。总体而言，46.3%的死者接受了社区和/或医院的专科姑息治疗；比十年前报告的专科姑息治疗获得率增加了3.5%（95%可信区间2.3 - 4.7）。大多数（69%；n = 4928）癌症死者在生命的最后一年接受了姑息治疗。只有14%（n = 729）的非癌症疾病死者接受了专科姑息治疗，然而，这比十年前同一死者群体报告的专科姑息治疗获得率增加了6.1%（95%可信区间4.9 - 7.3）。与心力衰竭死者相比，癌症死者（比值比10.5；95%可信区间9.1 - 12.2）、肾衰竭死者（比值比1.5；95%可信区间1.3 - 1.9）、肝衰竭死者（比值比2.3；95%可信区间1.7 - 3.3）或运动神经元病死者（比值比4.5；95%可信区间3.1 - 6.6）获得姑息治疗的几率增加。居住在大城市、女性、有伴侣和居住在私人住宅与获得专科姑息治疗的几率增加有关。
结论
西澳大利亚州获得专科姑息治疗服务的机会有小幅但显著的增加，特别是在死于非癌症疾病的患者中。
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