Bruyère Research Institute, Department of Family Medicine, University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute.
Health Analysis Division, Statistics Canada, Ottawa, Ontario.
Health Rep. 2020 Oct 21;31(10):3-13. doi: 10.25318/82-003-x202001000001-eng.
Palliative care (PC) has been shown to improve outcomes for individuals at the end of life. Despite this, many Canadians do not receive PC prior to death. The present study examines the receipt of inpatient PC and its association with location of death, as well as with admission to intensive care units (ICUs) and use of alternate level of care (ALC) beds in hospital in the last 30 days of life.
The study sample is a retrospective cohort of adult Canadians (aged 19 and older) who died between April 1, 2010, and December 31, 2014. Deaths were ascertained from the Canadian Vital Statistics Database and linked to hospitalizations records in the Discharge Abstract Database to identify the receipt of inpatient PC.
More than half (57.7%) of Canadian adults died in hospital, with only 12.6% receiving any inpatient PC in the year prior to death, and 1.7% receiving a preterminal PC designation (i.e., PC initiated prior to the last 30 days of life). In the adjusted analyses, receipt of any inpatient PC was associated with a higher likelihood of death in hospital but lower odds of ICU admission. Pre-terminal PC was associated with lower odds of death in hospital, ICU admission and ALC bed use.
This study offers new insights into the association between inpatient PC and outcomes at the end of life among Canadians. Future studies could expand on these observations to further understanding of the role of inpatient PC in the end-of-life experience for different populations in Canada.
姑息治疗（PC）已被证明可以改善生命末期个体的结局。尽管如此，仍有许多加拿大人在死亡前没有接受 PC。本研究检查了住院 PC 的接受情况及其与死亡地点的关系，以及与在生命的最后 30 天内入住重症监护病房（ICU）和使用医院的替代水平护理（ALC）床位的关系。
研究样本是一组回顾性的成年加拿大人（19 岁及以上）队列，他们在 2010 年 4 月 1 日至 2014 年 12 月 31 日期间死亡。死亡情况是从加拿大生命统计数据库中确定的，并与出院摘要数据库中的住院记录相联系，以确定住院 PC 的接受情况。
超过一半（57.7%）的加拿大成年人在医院死亡，只有 12.6%的人在死亡前一年接受过任何住院 PC，1.7%的人接受过临终前 PC 诊断（即 PC 在生命的最后 30 天之前开始）。在调整分析中，任何住院 PC 的接受都与更高的医院死亡可能性相关，但与 ICU 入院的可能性较低相关。临终前 PC 与医院、ICU 入院和 ALC 床位使用的死亡可能性较低相关。
本研究为加拿大人生存末期住院 PC 与结局之间的关系提供了新的见解。未来的研究可以进一步扩展这些观察结果，以进一步了解住院 PC 在加拿大不同人群的临终体验中的作用。
