Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, North Yorkshire, UK
Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, North Yorkshire, UK.
BMJ Support Palliat Care. 2021 Mar;11(1):7-16. doi: 10.1136/bmjspcare-2019-002097. Epub 2020 May 11.
Hospital death is comparatively common in people with haematological cancers, but little is known about patient preferences. This study investigated actual and preferred place of death, concurrence between these and characteristics of preferred place discussions.
Set within a population-based haematological malignancy patient cohort, adults (≥18 years) diagnosed 2004-2012 who died 2011-2012 were included (n=963). Data were obtained via routine linkages (date, place and cause of death) and abstraction of hospital records (diagnosis, demographics, preferred place discussions). Logistic regression investigated associations between patient and clinical factors and place of death, and factors associated with the likelihood of having a preferred place discussion.
Of 892 patients (92.6%) alive 2 weeks after diagnosis, 58.0% subsequently died in hospital (home, 20.0%; care home, 11.9%; hospice, 10.2%). A preferred place discussion was documented for 453 patients (50.8%). Discussions were more likely in women (p=0.003), those referred to specialist palliative care (p0.001), and where cause of death was haematological cancer (p0.001); and less likely in those living in deprived areas (p=0.005). Patients with a discussion were significantly (p<0.05) less likely to die in hospital. Last recorded preferences were: home (40.6%), hospice (18.1%), hospital (17.7%) and care home (14.1%); two-thirds died in their final preferred place. Multiple discussions occurred for 58.3% of the 453, with preferences varying by proximity to death and participants in the discussion.
Challenges remain in ensuring that patients are supported to have meaningful end-of-life discussions, with healthcare services that are able to respond to changing decisions over time.
血液系统恶性肿瘤患者的院内死亡率相对较高，但患者的偏好鲜为人知。本研究调查了实际和首选的死亡地点，以及这些地点与首选地点讨论的一致性，以及这些讨论的特征。
本研究纳入了 2004 年至 2012 年间诊断、2011 年至 2012 年期间死亡的 963 名基于人群的血液恶性肿瘤患者队列中的成年人（≥18 岁）。数据通过常规链接（死亡日期、地点和原因）和医院记录（诊断、人口统计学、首选地点讨论）提取获得。逻辑回归分析了患者和临床因素与死亡地点之间的关系，以及与进行首选地点讨论可能性相关的因素。
在诊断后 2 周仍存活的 892 名患者中，有 58.0%最终死于医院（家中，20.0%；护理院，11.9%；临终关怀，10.2%）。有 453 名患者（50.8%）记录了首选地点讨论。女性（p=0.003）、转介至专科姑息治疗（p<0.001）和死因是血液系统癌症（p<0.001）的患者更有可能进行讨论；而居住在贫困地区的患者（p=0.005）则不太可能进行讨论。进行讨论的患者显著（p<0.05）更不可能死于医院。最后记录的首选地点为：家中（40.6%）、临终关怀（18.1%）、医院（17.7%）和护理院（14.1%）；三分之二的患者在他们的最终首选地点死亡。453 名患者中有 58.3%进行了多次讨论，讨论的偏好随死亡的临近程度和讨论参与者的变化而变化。
在确保患者得到支持以进行有意义的临终讨论方面仍存在挑战，需要医疗保健服务能够随着时间的推移应对不断变化的决策。
