晚期癌症患者的临终关怀规划与在家中离世：一项结构化访谈分析
Advance care planning and home death in patients with advanced cancer: a structured interview analysis.
作者信息
Ishikawa Takako, Fukui Sakiko, Okamoto Yuko
机构信息
Assistant Professor, Faculty of Nursing, National Defense Medical College, Tokorozawa, Saitama, Japan.
Professor, Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan.
出版信息
Int J Palliat Nurs. 2018 Sep 2;24(9):418-426. doi: 10.12968/ijpn.2018.24.9.418.
BACKGROUND
: Discrepancy between preferred and actual place of death is common in patients with advanced cancer.
AIM
: To investigate the association between advance care planning (ACP) and home death in patients with advanced cancer.
METHODS
: Using structured interviews, 44 primary nurses from 19 home-visit nursing agencies in Japan were asked about status changes for 123 advanced cancer patients receiving home care. The main outcome was the place of death.
RESULTS
: Of the 123 patients, 16 were alive, 54 died at home and 53 died at hospital. Multivariate analyses revealed that home death was more likely if: i) physicians or nurses practised ACP during the whole home-visit period (odds ratio (OR) 41.76; confidence interval (CI) 5.87-297.07); ii) patients had adequate insight concerning their prognosis just before death or at hospitalisation (OR 7.85; CI 1.18-52.24); and iii) the baseline preference of families was a home death (OR 0.09; 95% CI 0.01-0.73).
CONCLUSION
: ACP practiced by physicians or nurses for advanced cancer patients may contribute to achieving home death.
背景
晚期癌症患者中，预期死亡地点与实际死亡地点之间的差异很常见。
目的
调查晚期癌症患者的临终关怀计划（ACP）与在家中死亡之间的关联。
方法
通过结构化访谈，询问了日本19家上门护理机构的44名初级护士有关123名接受家庭护理的晚期癌症患者的状态变化。主要结局是死亡地点。
结果
123名患者中，16人存活，54人在家中死亡，53人在医院死亡。多因素分析显示，如果满足以下条件，则在家中死亡的可能性更大：i）医生或护士在整个上门护理期间实施了临终关怀计划（优势比（OR）41.76；置信区间（CI）5.87 - 297.07）；ii）患者在死亡前或住院时对自己的预后有充分的了解（OR 7.85；CI 1.18 - 52.24）；iii）家属的基线偏好是在家中死亡（OR 0.09；95% CI 0.01 - 0.73）。
结论
医生或护士为晚期癌症患者实施临终关怀计划可能有助于实现在家中死亡。
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