对瑞士南部癌症患者死亡地点的影响：因果探索。
Impact on place of death in cancer patients: a causal exploration in southern Switzerland.
机构信息
Triangolo Association, In Sceresòra 4, CH-6528, Camorino, Switzerland.
IDSIA, Dalle Molle Institute for Artificial Intelligence, Galleria 2, Via Cantonale 2c, CH-6928, Manno, Switzerland.
出版信息
BMC Palliat Care. 2020 Oct 15;19(1):160. doi: 10.1186/s12904-020-00664-4.
BACKGROUND
Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care.
METHODS
A data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review.
RESULTS
Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family's preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient's preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%.
CONCLUSION
Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family's decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.
背景
大多数绝症癌症患者更愿意在家中离世，但大多数患者却在医疗机构去世。对于这一差异的研究尚未得到充分解答。本研究应用人工智能和机器学习技术来探索影响死亡地点的复杂因素网络和因果关系，最终目标是制定支持在家中进行临终关怀的政策。
方法
采用数据挖掘算法和因果概率模型进行数据分析，该模型的信息来源于专家知识，并与来自瑞士南部 116 名已故癌症患者的数据合并。该数据集是通过回顾性临床图表审查获得的。
结果
疾病和治疗相关决策的依赖性表明，其对死亡地点的影响为 13%。晚期疾病中的抗癌治疗会阻止或延迟肿瘤学家、患者和家属之间就生命末期进行沟通。对死亡地点的未知偏好是在家中死亡的一大障碍。另一个障碍是，临终家庭护理的家庭护理人员有限。家庭对最后护理地点的偏好对死亡地点有很大影响，占 51%，而患者偏好的影响较小，为 14%。大约三分之一的家庭系统可以通过临终关怀的开放性沟通和良好的症状管理，来获得医疗保健专业人员的授权，以提供家庭护理。这种干预对死亡地点有 17%的影响。如果家属强烈表达了对家庭护理的偏好，那么引入专业的姑息治疗家庭护理服务可以将在家中死亡的概率提高 24%。
结论
在家中离世方面，公开讨论死亡和临终事宜至关重要。此外，为了尊重患者对家庭护理的偏好，家庭对最后护理地点的决定似乎是关键。建议早期启动以家庭为中心的姑息治疗，并为希望在家中离世的患者提供专业的姑息治疗家庭护理。
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