Epidemiology and Health Analytics, Western Sydney Local Health District, New South Wales, Australia.
Epidemiology, Healthy People and Places Unit, South Western Sydney Local Health District, New South Wales, Australia.
Intern Med J. 2019 Feb;49(2):232-239. doi: 10.1111/imj.14074.
Palliative care can benefit all patients with life-limiting diseases.
To describe hospital use in the final year of life, timing of palliative care and variations by age and disease for patients receiving inpatient palliative care.
Retrospective cohort study of all New South Wales residents aged 50 years and older who died (decedents) between July 2010 and June 2015 in hospital or within 30 days of discharge. Care type and diagnosis codes identified decedents who received inpatient palliative care.
Of 150 770 decedents, 34.4% received palliative care a median of 10 days before death. Decedents were more likely to receive palliative care if they had cancer (64.7% vs 13.3% for those without chronic conditions) or were younger (46.3% vs 25.0% of the oldest decedents). In their last year of life, palliated decedents, on average, had three emergency department presentations and four hospital admissions - one involving surgery and one where palliation was the intent of care. Of the 30.1 days spent in hospital, 8.7 days involved palliative care. Older age and non-cancer diagnoses were associated with fewer days of inpatient palliation and shorter time between first palliative admission and death. Decedents dying out of hospital started palliative care 18 days earlier than those dying in hospital.
Most decedents did not receive palliative care during hospital admission, and even then only very late in life, limiting its benefits. Improved recognition of palliative need, including earlier identification regardless of age and disease, will enhance the quality of care for the dying.
姑息治疗可以使所有患有生命终末期疾病的患者受益。
描述生命终末期患者的住院情况、姑息治疗的时机以及接受住院姑息治疗患者的年龄和疾病差异。
这是一项回顾性队列研究，纳入了 2010 年 7 月至 2015 年 6 月期间在医院内或出院后 30 天内死亡的所有 50 岁及以上新南威尔士州居民（死者）。使用护理类型和诊断代码来识别接受住院姑息治疗的死者。
在 150770 名死者中，34.4%在死亡前 10 天中位数接受姑息治疗。如果死者患有癌症（64.7%比无慢性疾病者的 13.3%）或年龄较小（46.3%比最年长死者的 25.0%），则更有可能接受姑息治疗。在生命的最后一年，姑息治疗的死者平均有 3 次急诊就诊和 4 次住院治疗——其中 1 次涉及手术，1 次姑息治疗是护理的目的。在住院的 30.1 天中，有 8.7 天涉及姑息治疗。年龄较大和非癌症诊断与住院姑息治疗天数较少以及首次姑息治疗入院和死亡之间的时间较短相关。在医院外死亡的死者比在医院内死亡的死者开始姑息治疗早 18 天。
大多数死者在住院期间未接受姑息治疗，即使在生命末期也仅接受非常晚期的姑息治疗，限制了其获益。提高对姑息治疗需求的认识，包括无论年龄和疾病，都尽早识别，将提高临终患者的护理质量。
