Division of Health Services Development for Persons with Disabilities, Ministry of Health and Welfare National Rehabilitation Center, 58 Samgaksan-ro, GangBuk-gu, Seoul, 01022, South Korea.
National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea.
Support Care Cancer. 2020 Jun;28(6):2713-2719. doi: 10.1007/s00520-019-05091-7. Epub 2019 Nov 5.
Many assert the need for home hospice care. However, limited research has shown its effectiveness. The authors of this study thus evaluated the effectiveness of a home hospice care pilot project regarding (1) early enrollment in hospice care, (2) efficient use of inpatient hospice resources, and (3) enabling terminally ill patients to stay at their preferred place of care.
The authors conducted a nationwide prospective observational study. Patients were divided into home hospice care users (ever-users, n = 902) and inpatient-only hospice care users (never-users, n = 8210). Information about hospice service utilization was collected from a web-based registry system. Patients were registered if they started to receive the hospice service after providing written informed consent during the pilot project from March 2016-July 2017.
Most ever-users preferred to stay at home (84.0%), while never-users preferred hospital admission (66.9%). Most ever-users were enrolled in hospice by home care (78.9%) and used both home and inpatient care (72.4%). The overall duration of hospice care was significantly longer among ever-users than never-users (median 39 vs. 15 days, respectively; mean ± SD 59.6 ± 62.8 vs. 24.8 ± 32.1, respectively; p < .001). Participation in the pilot program improved bed utilization (p = .025) and turnover rate (p < .001) of inpatient hospice service.
Home hospice care enabled early enrollment in hospice services and provided a valid option to patients who wished to stay at home. Policy efforts to facilitate home hospice care are needed.
许多人主张需要家庭临终关怀服务。然而，有限的研究表明其有效性。因此，本研究的作者评估了家庭临终关怀试点项目在以下方面的有效性：（1）早期接受临终关怀，（2）高效利用住院临终关怀资源，以及（3）使绝症患者能够留在他们首选的护理场所。
作者进行了一项全国范围的前瞻性观察研究。患者分为家庭临终关怀使用者（曾使用者，n = 902）和仅住院临终关怀使用者（从未使用者，n = 8210）。通过基于网络的注册系统收集临终关怀服务利用信息。如果患者在试点项目期间（2016 年 3 月至 2017 年 7 月）书面同意后开始接受临终关怀服务，则将其注册。
大多数曾使用者更喜欢待在家里（84.0%），而从未使用者更喜欢住院（66.9%）。大多数曾使用者通过家庭护理（78.9%）和家庭和住院护理（72.4%）接受临终关怀。曾使用者的临终关怀总持续时间明显长于从未使用者（中位数分别为 39 天和 15 天；平均值 ±标准差分别为 59.6 ± 62.8 天和 24.8 ± 32.1 天；p <.001）。参与试点计划改善了住院临终关怀服务的床位利用率（p =.025）和周转率（p <.001）。
家庭临终关怀使早期接受临终关怀服务成为可能，并为希望在家中接受护理的患者提供了有效的选择。需要努力制定政策来促进家庭临终关怀。
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