1 Hull York Medical School, University of Hull, Hull, UK.
2 Hull York Medical School, University of York, York, UK.
Palliat Med. 2018 Feb;32(2):357-365. doi: 10.1177/0269216317711825. Epub 2017 Jun 7.
Previous work shows that more affluent patients with cancer are more likely to die at home, whereas those dying from non-cancer conditions are more likely to die in hospital. Family caregivers are an important factor in determining place of death.
To investigate associations between family caregivers' household income, patients' access to specialist palliative care and place of patients' death, by level of personal end-of-life care.
A cross-sectional community household population survey.
Respondents to the Household Survey for England.
One-third of 1265 bereaved respondents had provided personal end-of-life care (caregivers) (30%). Just over half (55%) of decedents accessed palliative care services and 15% died in a hospice. Place of death and access to palliative care were strongly related ( p < 0.001). Palliative care services reduced the proportion of deaths in hospital ( p < 0.001), and decedents accessing palliative care were more likely to die at home than those who did not ( p < 0.001). Respondents' income was not associated with palliative care access ( p = 0.233). Overall, respondents' income and home death were not related ( p = 0.106), but decedents with caregivers in the highest income group were least likely to die at home ( p = 0.069).
For people who had someone close to them die, decedents' access to palliative care services was associated with fewer deaths in hospital and more home deaths. Respondents' income was unrelated to care recipients' place of death when adjusted for palliative care access. When only caregivers were considered, decedents with caregivers from higher income quartiles were the least likely to die at home. Family caregivers from higher income brackets are likely to be powerful patient advocates. Caregiver information needs must be addressed especially with regard to stage of disease, aim of care and appropriate interventions at the end of life.
先前的研究表明，较富裕的癌症患者更有可能在家中去世，而非癌症患者则更有可能在医院去世。家庭护理人员是决定患者死亡地点的一个重要因素。
通过个人临终关怀服务的水平，调查家庭护理人员家庭收入、患者获得专科姑息治疗与患者死亡地点之间的关系。
横断面社区家庭人群调查。
英格兰家庭调查的应答者。
1265 名丧亲应答者中有三分之一（30%）提供了个人临终关怀（护理人员）。略超过一半（55%）的死者接受了姑息治疗服务，15%的人在临终关怀机构去世。死亡地点和获得姑息治疗服务密切相关（p<0.001）。姑息治疗服务降低了在医院死亡的比例（p<0.001），接受姑息治疗的死者比未接受的更有可能在家中去世（p<0.001）。护理人员的收入与获得姑息治疗服务无关（p=0.233）。总体而言，护理人员的收入与在家中去世无关（p=0.106），但在收入最高组的护理人员中，死者在家中去世的可能性最小（p=0.069）。
对于有亲近的人去世的人来说，患者获得姑息治疗服务与在医院死亡的人数减少和在家中死亡的人数增加有关。在调整了姑息治疗服务的获得情况后，护理人员的收入与接受护理者的死亡地点无关。仅考虑护理人员时，来自收入较高四分位数的死者最不可能在家中去世。来自收入较高阶层的家庭护理人员可能是强有力的患者代言人。必须满足护理人员的信息需求，特别是在疾病的阶段、护理的目的和生命末期的适当干预方面。
