Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Programa Medicina Paliativa y Cuidados Continuos, Pontificia Universidad Católica de Chile Facultad de Medicina, Santiago, Chile.
BMJ Support Palliat Care. 2022 Oct;12(e4):e501-e504. doi: 10.1136/bmjspcare-2019-002019. Epub 2020 Apr 6.
Meeting the preferences of patients is considered an important palliative care outcome. Prior studies reported that more than 80% of patients with terminally ill cancer prefer to die at home. The purpose of this study was to determine place-of-death preference among palliative care patients in the outpatient centre and the palliative care unit (PCU) of a comprehensive cancer centre.
A cross-sectional anonymous questionnaire was administered to patients with advanced cancer and caregivers (PCU and outpatient centre) between August 2012 and September 2014. PCU patients responded when there was no delirium and the primary caregiver responded when the patient was unable to respond. In the case of outpatients, dyads were assessed. The survey was repeated 1 month later.
Overall, 65% preferred home death. There was less preference for home death among PCU patients (58%) than among outpatients (72%). Patient and caregiver agreement regarding preferred place of death for home was 86%. After 1 month, outpatients were significantly more likely than PCU patients to have the same preferred place of death as they had 1 month earlier (96% vs 83%; p=0.003).
Although home was the preferred place of death in our group of patients with advanced cancer and their caregivers, a substantial minority preferred hospital death or had no preference. We speculate that PCU patients' higher preference for hospital death is likely related to more severe distress because they had already tried home care. Personalised assessment of place of death preference for both patient and caregiver is needed.
满足患者的偏好被认为是姑息治疗的一个重要结果。先前的研究报告称，80%以上患有绝症的癌症患者更愿意在家中去世。本研究旨在确定综合癌症中心的姑息治疗门诊中心和姑息治疗病房（PCU）中姑息治疗患者的死亡地点偏好。
2012 年 8 月至 2014 年 9 月期间，对晚期癌症患者及其护理人员（PCU 和门诊中心）进行了横断面匿名问卷调查。当 PCU 患者没有谵妄时，PCU 患者会做出回应，当患者无法做出回应时，由主要护理人员做出回应。对于门诊患者，评估了对偶体。一个月后重复了调查。
总体而言，65%的人更喜欢在家中去世。PCU 患者（58%）比门诊患者（72%）更倾向于在家中去世。患者和护理人员对在家中去世的首选地点的意见一致率为 86%。一个月后，门诊患者与一个月前相比，更有可能与 PCU 患者有相同的首选死亡地点（96%比 83%；p=0.003）。
尽管在家中是我们组患有晚期癌症的患者及其护理人员的首选死亡地点，但仍有相当一部分人更喜欢在医院死亡或没有偏好。我们推测，PCU 患者更倾向于在医院死亡可能与更严重的痛苦有关，因为他们已经尝试过家庭护理。需要对患者和护理人员的死亡地点偏好进行个性化评估。
