National Institute of Health, Roma, Italy.
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy.
Acta Oncol. 2020 Jun;59(6):620-627. doi: 10.1080/0284186X.2020.1736335. Epub 2020 Mar 9.
Advanced cancer patients often die in hospital after receiving needless, aggressive treatment. Although palliative care improves symptom management, barriers to accessing palliative care services affect its utilisation, and such disparities challenge the equitable provision of palliative care. This study aimed to identify which factors are associated with inequitable palliative care service utilisation among advanced cancer patients by applying the Andersen Behavioural Model of Health Services Use. This was a retrospective cohort study using administrative healthcare data. A total of 13,656 patients residing in the Lazio region of Italy, who died of an advanced cancer-related cause-either in hospital or in a specialised palliative care facility-during the period of 2012-2016 were included in the study. Potential predictors of specialised palliative service utilisation were explored by grouping the following factors: predisposing factors (i.e., individuals' characteristics), enabling factors (i.e., systemic/structural factors) and need factors (i.e., type/severity of illness). The logistic hierarchical regression showed that older patients (odds ratio [OR] = 1.45; <0.0001) of Caucasian ethnicity (OR = 4.17; 0.02), with a solid tumour (OR = 1.87; <0.0001) and with a longer survival time (OR = 2.09; <0.0001) were more likely to be enrolled in a palliative care service. Patients who lived farther from a specialised palliative care facility (OR = 0.13; <0.0001) and in an urban area (OR = 0.58; <0.0001) were less likely to be enrolled. This study found that socio-demographic (age, ethnicity), clinical (type of tumour, survival time) and organisational (area of residence, distance from service) factors affect the utilisation of specialised palliative care services. The fact that service utilisation is not only a function of patients' needs but also of other aspects demonstrates the presence of inequity in access to palliative care among advanced cancer patients.
晚期癌症患者在接受不必要的激进治疗后常在医院死亡。尽管姑息治疗可改善症状管理，但获得姑息治疗服务的障碍会影响其利用，这种差异挑战了姑息治疗的公平提供。本研究旨在应用安德森卫生服务利用行为模型，确定哪些因素与晚期癌症患者姑息治疗服务利用的不公平有关。这是一项使用行政医疗保健数据的回顾性队列研究。总共纳入了 13656 名居住在意大利拉齐奥地区的患者，他们在 2012 年至 2016 年间死于晚期癌症相关原因，无论是在医院还是在专门的姑息治疗机构。通过将以下因素分组，探讨了专门姑息服务利用的潜在预测因素：倾向因素（即个体特征）、促成因素（即系统/结构性因素）和需要因素（即疾病类型/严重程度）。逻辑层次回归显示，年龄较大（优势比 [OR] = 1.45；<0.0001）、白种人（OR = 4.17；0.02）、患有实体瘤（OR = 1.87；<0.0001）和生存时间较长（OR = 2.09；<0.0001）的患者更有可能被纳入姑息治疗服务。居住在离专门姑息治疗机构较远（OR = 0.13；<0.0001）和城市地区（OR = 0.58；<0.0001）的患者不太可能被纳入。本研究发现，社会人口统计学（年龄、种族）、临床（肿瘤类型、生存时间）和组织（居住地、与服务的距离）因素影响专门姑息治疗服务的利用。服务利用不仅是患者需求的函数，还受到其他方面的影响，这表明晚期癌症患者获得姑息治疗存在不公平现象。
