The Royal Marsden NHS Foundation Trust, London, United Kingdom.
Institute for Global Health Innovation, Imperial College London, London, United Kingdom.
PLoS One. 2020 Dec 9;15(12):e0242914. doi: 10.1371/journal.pone.0242914. eCollection 2020.
Place of death is an important outcome of end-of-life care. Many people do not have the opportunity to express their wishes and die in their preferred place of death. Advance care planning (ACP) involves discussion, decisions and documentation about how an individual contemplates their future death. Recording end-of-life preferences gives patients a sense of control over their future. Coordinate My Care (CMC) is London's largest electronic palliative care register designed to provide effective ACP, with information being shared with urgent care providers. The aim of this study is to explore determinants of dying in hospital. Understanding advance plans and their outcomes can help in understanding the potential effects that implementation of electronic palliative care registers can have on the end-of-life care provided. Retrospective observational cohort analysis included 21,231 individuals aged 18 or older with a Coordinate My Care plan who had died between March 2011 and July 2019 with recorded place of death. Logistic regression was used to explore demographic and end-of-life preference factors associated with hospital deaths. 22% of individuals died in hospital and 73% have achieved preferred place of death. Demographic characteristics and end-of-life preferences have impact on dying in hospital, with the latter having the strongest influence. The likelihood of in-hospital death is substantially higher in patients without documented preferred place of death (OR = 1.43, 95% CI 1.26-1.62, p<0.001), in those who prefer to die in hospital (OR = 2.30, 95% CI 1.60-3.30, p<0.001) and who prefer to be cared in hospital (OR = 2.77, 95% CI 1.94-3.96, p<0.001). "Not for resuscitation" individuals (OR = 0.43, 95% CI 0.37-0.50, p<0.001) and who preferred symptomatic treatment (OR = 0.36, 95% CI 0.33-0.40, p<0.001) had a lower likelihood of in-hospital death. Effective advance care planning is necessary for improved end-of-life outcomes and should be included in routine clinical care. Electronic palliative care registers could empower patients by embedding patients' wishes and personal circumstances in their care plans that are accessible by urgent care providers.
死亡地点是临终关怀的一个重要结果。许多人没有机会表达自己的意愿，也没有在他们喜欢的地方去世。预先护理计划（ACP）涉及关于个人对未来死亡的思考的讨论、决策和记录。记录临终偏好可以让患者对自己的未来有控制感。协调我的护理（CMC）是伦敦最大的电子姑息治疗登记处，旨在提供有效的 ACP，并与紧急护理提供者共享信息。本研究旨在探讨导致在医院死亡的决定因素。了解预先计划及其结果有助于理解实施电子姑息治疗登记处可能对所提供的临终关怀产生的潜在影响。回顾性观察队列分析包括 2011 年 3 月至 2019 年 7 月期间在 CMC 计划中有记录的死亡地点的年龄在 18 岁或以上的 21231 名个体。使用逻辑回归探讨与医院死亡相关的人口统计学和临终偏好因素。22%的人在医院死亡，73%的人实现了首选的死亡地点。人口统计学特征和临终偏好对在医院死亡有影响，后者影响最大。在没有记录首选死亡地点的患者（OR=1.43，95%CI 1.26-1.62，p<0.001）、倾向于在医院死亡的患者（OR=2.30，95%CI 1.60-3.30，p<0.001）和倾向于在医院接受护理的患者（OR=2.77，95%CI 1.94-3.96，p<0.001）中，在医院死亡的可能性要高得多。“不复苏”患者（OR=0.43，95%CI 0.37-0.50，p<0.001）和倾向于接受症状治疗的患者（OR=0.36，95%CI 0.33-0.40，p<0.001）在医院死亡的可能性较低。有效的预先护理计划对于改善临终结果是必要的，应纳入常规临床护理。电子姑息治疗登记处可以通过将患者的意愿和个人情况嵌入到他们的护理计划中，为患者提供赋权，这些护理计划可供紧急护理提供者访问。
