Centre for Public Health,Queen's University Belfast,Belfast,United Kingdom.
Northern Ireland Cancer Registry,Centre for Public Health,Queen's University Belfast,United Kingdom.
Palliat Support Care. 2018 Dec;16(6):749-755. doi: 10.1017/S1478951517000876. Epub 2017 Nov 23.
ABSTRACTObjectives:Most terminally ill cancer patients prefer to die at home, yet only a minority are able to achieve this. Our aim was to investigate the factors associated with cancer patients achieving their preference to die at home.
This study took the form of a mortality followback, population-based, observational survey of the relatives of deceased cancer patients in Northern Ireland. Individuals who registered the death of a friend or relative (aged ≥ 18 years) between 1 December 2011 and 31 May 2012, where the primary cause of death was cancer (ICD10: C00-D48), who were invited to take part. Preferred and actual place of death, and patient, service, and clinical data were collected using the QUALYCARE postal questionnaire. Multivariable logistic regression was employed to investigate the factors associated with achieving a home death when preferred.
Some 467 of 1,493 invited informants completed the survey. The 362 (77.5%) who expressed a preference for dying at home and spent time at home in their final 3 months were included in our analysis. Of these, 53.4% achieved their preference of a home death. Factors positively associated with achieving a home death were: living in an affluent area, receipt of good and satisfactory district nurse care, discussing place of death with health professionals, and the caregiver's preference for a home death. Being older than 80 years of age, being a Presbyterian, and being unconscious most of the time during their final week were negatively associated with achieving a home death.
Communication, care satisfaction, and caregiver preferences were all associated with home death. Our findings will help inform the design of future interventions aimed at increasing the proportion of patients achieving their preferred place of death at home, for example, by targeting interventions toward older patients and those from the most deprived communities.
大多数临终癌症患者希望在家中离世，但只有少数人能够实现这一愿望。本研究旨在调查与癌症患者实现其在家中离世偏好相关的因素。
本研究采用死亡后随访的方式，对北爱尔兰癌症患者亲属进行了基于人群的观察性调查。符合以下条件的个体被邀请参与研究：在 2011 年 12 月 1 日至 2012 年 5 月 31 日期间，其朋友或亲属（年龄≥18 岁）因癌症（ICD10：C00-D48）去世，且其主要死因是癌症；并邀请他们参加研究。使用 QUALYCARE 邮寄问卷收集患者偏好和实际死亡地点、患者、服务和临床数据。采用多变量逻辑回归分析调查与实现居家死亡相关的因素。
在邀请的 1493 位知情人中，有 467 位完成了调查。在表示希望在家中离世且在生命的最后 3 个月中有时间在家中的 362 位受访者中，有 53.4%的人实现了其在家中离世的偏好。与实现居家死亡相关的因素有：居住在富裕地区、接受良好和满意的地区护士护理、与卫生专业人员讨论死亡地点、以及照顾者希望在家中死亡。年龄超过 80 岁、长老会教友以及在生命的最后一周大部分时间处于无意识状态与实现居家死亡呈负相关。
沟通、护理满意度和照顾者偏好均与居家死亡相关。我们的研究结果将有助于指导未来干预措施的设计，旨在提高患者在家中离世的比例，例如，针对老年患者和来自最贫困社区的患者开展干预措施。
