VA Boston Healthcare System, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Dana Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
J Pain Symptom Manage. 2017 Dec;54(6):789-797. doi: 10.1016/j.jpainsymman.2017.08.013. Epub 2017 Aug 24.
Older adults with end-stage renal disease (ESRD) are a rapidly growing group of seriously ill patients. Yet, despite a mortality rate almost twice that of cancer, less is known about the impact of ESRD on patients' end-of-life experience.
To compare the end-of-life experience of older adults who died of ESRD vs. cancer.
We used data from the Health and Retirement Study, a nationally representative survey of older adults. Our sample included 1883 Health and Retirement Study participants who died of cancer or ESRD between 2000 and 2010 and their family respondents. We compared advance care planning, treatment intensity, and symptoms between the two groups and used propensity score weighting to adjust for differences by diagnosis.
Among propensity-weighted cohorts, older adults with ESRD, compared with similar patients with cancer, were less likely to have end-of-life instructions (adjusted proportions 38.5% vs. 49.7%; P = 0.005) and were more likely to die in the hospital (53.5% vs. 29.0%; P < 0.001) and to use the intensive care unit in the last two years of life (57.1% vs. 37.0%; P < 0.001). Decedents with ESRD and cancer had similarly high rates of moderate or severe pain (53.7% vs. 57.8%; P = 0.34) and all other symptoms.
Older adults dying of ESRD had lower rates of advance care planning and higher treatment intensity near the end of life than similar patients dying of cancer; both groups had similarly high rates of symptoms. Efforts are needed to make treatment more supportive and alleviate suffering for older adults with ESRD and their families near the end of life.
终末期肾病（ESRD）患者是一个快速增长的重病群体。然而，尽管他们的死亡率几乎是癌症的两倍，但人们对 ESRD 对患者临终体验的影响知之甚少。
比较死于 ESRD 和癌症的老年患者的临终体验。
我们使用了来自健康与退休研究（Health and Retirement Study）的数据，这是一项对老年人群的全国代表性调查。我们的样本包括了 1883 名在 2000 年至 2010 年间死于癌症或 ESRD 的健康与退休研究参与者及其家属受访者。我们比较了两组患者的预先护理计划、治疗强度和症状，并使用倾向评分加权来调整诊断差异。
在倾向评分加权的队列中，与患有相似癌症的患者相比，患有 ESRD 的老年患者更不可能有临终指示（调整后的比例为 38.5%比 49.7%；P=0.005），更有可能在医院死亡（53.5%比 29.0%；P<0.001），并且在生命的最后两年更有可能使用重症监护病房（57.1%比 37.0%；P<0.001）。患有 ESRD 和癌症的死者有类似高比例的中度或重度疼痛（53.7%比 57.8%；P=0.34）和所有其他症状。
与患有相似癌症的患者相比，死于 ESRD 的老年患者在临终前的预先护理计划率较低，治疗强度较高；两组患者的症状发生率相似。需要努力使治疗更具支持性，并减轻 ESRD 患者及其家属在生命末期的痛苦。
