School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.
General Practice Academic Unit, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia.
Int J Environ Res Public Health. 2020 Jul 9;17(14):4955. doi: 10.3390/ijerph17144955.
Despite the advances in End-of-life (EOL) cancer care, disparities remain in the accessibility and utilisation of EOL cancer care resources. Often explained by socio-demographic factors, geographic variation exists in the availability and provision of EOL cancer care services among EOL cancer decedents across urban versus rural settings. This systematic review aims to synthesise mortality follow-back studies on the patterns of EOL cancer care resource use for adults (>18 years) during end-of-life cancer care.
Five databases were searched and data analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria involved; a) original research; b) quantitative studies; c) English language; d) palliative care related service use in adults (>18 years) with any malignancy excluding non-melanoma skin cancers; e) exclusive end of life focus; f) urban-rural focus. Narrative reviews and discussions were excluded.
24 studies met the inclusion criteria. End-of-life cancer care service utilisation patterns varied by rurality and treatment intent. Rurality was strongly associated with higher rates of Emergency Department (ED) visits and hospitalisations and lower rates of hospice care. The largest inequities between urban and rural health service utilisation patterns were explained by individual level factors including age, gender, proximity to service and survival time from cancer diagnosis.
Rurality is an important predictor for poorer outcomes in end-of-life cancer care. Findings suggest that addressing the disparities in the urban-rural continuum is critical for efficient and equitable palliative cancer care. Further research is needed to understand barriers to service access and usage to achieve optimal EOL care for all cancer patient populations.
尽管在临终关怀（EOL）癌症护理方面取得了进展，但在获得和利用 EOL 癌症护理资源方面仍然存在差异。这些差异通常可以用社会人口因素来解释，在城市和农村环境中，临终癌症患者获得和提供 EOL 癌症护理服务的情况存在地域差异。本系统评价旨在综合关于成人（>18 岁）在临终期癌症护理期间 EOL 癌症护理资源使用模式的死亡随访研究。
搜索了五个数据库，并按照系统评价和荟萃分析的首选报告项目指南进行了数据分析。纳入标准包括：a）原始研究；b）定量研究；c）英语语言；d）不包括非黑色素瘤皮肤癌的姑息治疗相关服务，成人（>18 岁）中任何恶性肿瘤；e）专门关注生命末期；f）城乡重点。排除叙述性评论和讨论。
符合纳入标准的研究有 24 项。临终期癌症护理服务的使用模式因农村和治疗意图而异。农村地区与急诊室（ED）就诊和住院率较高，而临终关怀率较低的情况密切相关。城乡卫生服务利用模式之间最大的不平等是由个体水平因素解释的，包括年龄、性别、接近服务和从癌症诊断到存活时间。
农村地区是临终期癌症护理结果较差的一个重要预测因素。研究结果表明，解决城乡连续体中的差异对于高效和公平的姑息治疗癌症护理至关重要。需要进一步研究以了解服务获取和使用的障碍，以实现所有癌症患者群体的最佳 EOL 护理。
