Hunt Roger W, D'Onise Katina, Nguyen Anh-Minh Thi, Venugopal Kamalesh
Central Adelaide Palliative Care Service, South Australia, Australia.
Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
J Palliat Care. 2019 Oct;34(4):224-231. doi: 10.1177/0825859718814813. Epub 2018 Nov 28.
To describe changes in the place of death of patients with cancer from 1990 to 2012, and to identify issues for their end-of-life care.
Population-based descriptive study, with analyses of place of death patterns, using the South Australian Cancer Registry records of 86 257 patients with cancer who died from 1990 to 2012.
From 1990 to 2012, the proportion of cancer deaths in hospital decreased from 63.4% to 50.9%, and in nursing homes increased from 8.2% to 22.5%. After the year 2000, the proportions in hospices and at home were both below 15%. Multivariate analyses showed that young patients with cancer were more likely to die in a hospice or at home, compared to elderly patients with cancer who were more likely to die in a nursing home; the likelihood of dying in a hospice increased with socioeconomic status; patients with a short survival time or a hematological malignancy were more likely to die in a metropolitan hospital.
Compared to most other countries, the proportion of cancer deaths at home was low, and many patients would not have died at their preferred place. The trend for more cancer deaths to occur in nursing homes is likely to continue, but nursing homes generally lack the resources and skilled staff to provide quality palliative care. Models of palliative care delivery should take account of patient preferences, the growth of terminal cancer care in nursing homes, and apparent inequities.
描述1990年至2012年癌症患者死亡地点的变化，并确定其临终关怀问题。
基于人群的描述性研究，通过分析死亡地点模式，使用南澳大利亚癌症登记处1990年至2012年期间86257例癌症死亡患者的记录。
1990年至2012年，医院内癌症死亡比例从63.4%降至50.9%，疗养院的比例从8.2%增至22.5%。2000年后，临终关怀机构和家中的比例均低于15%。多因素分析显示，与老年癌症患者更可能在疗养院死亡相比，年轻癌症患者更可能在临终关怀机构或家中死亡；在临终关怀机构死亡的可能性随社会经济地位的提高而增加；生存时间短或患有血液系统恶性肿瘤的患者更可能在大都市医院死亡。
与大多数其他国家相比，在家中癌症死亡的比例较低，许多患者并非在其首选地点死亡。癌症死亡在疗养院发生的趋势可能会持续，但疗养院普遍缺乏提供高质量姑息治疗的资源和专业人员。姑息治疗模式应考虑患者偏好、疗养院终末期癌症护理的增长以及明显的不平等现象。
