O'Sullivan Anna, Alvariza Anette, Öhlén Joakim, Ex Håkanson Cecilia Larsdotter
Department of Healthcare Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
Capio Palliative Care, Stockholm, Sweden.
Palliat Support Care. 2021 Dec;19(6):664-671. doi: 10.1017/S147895152100016X.
To investigate the influence of care place and diagnosis on care communication during the last 3 months of life for people with advanced illness, from the bereaved family members' perspective.
A retrospective survey design using the VOICES(SF) questionnaire with a sample of 485 bereaved family members (aged: 20-90 years old, 70% women) of people who died in hospital was employed to meet the study aim.
Of the deceased people, 79.2% had at some point received care at home, provided by general practitioners (GPs) (52%), district nurses (36.7%), or specialized palliative home care (17.9%), 27.4% were cared for in a nursing home and 15.7% in a specialized palliative care unit. The likelihood of bereaved family members reporting that the deceased person was treated with dignity and respect by the staff was lowest in nursing homes (OR: 0.21) and for GPs (OR: 0.37). A cancer diagnosis (OR: 2.36) or if cared for at home (OR: 2.17) increased the likelihood of bereaved family members reporting that the deceased person had been involved in decision making regarding care and less likely if cared for in a specialized palliative care unit (OR: 0.41). The likelihood of reports of unwanted decisions about the care was higher if cared for in a nursing home (OR: 1.85) or if the deceased person had a higher education (OR: 2.40).
This study confirms previous research about potential inequalities in care at the end of life. The place of care and diagnosis influenced the bereaved family members' reports on whether the deceased person was treated with respect and dignity and how involved the deceased person was in decision making regarding care.
从丧亲家庭成员的角度，调查护理场所和诊断对晚期疾病患者生命最后3个月护理沟通的影响。
采用回顾性调查设计，使用VOICES(SF)问卷，对485名在医院死亡患者的丧亲家庭成员（年龄：20 - 90岁，70%为女性）进行抽样，以实现研究目的。
在已故患者中，79.2%曾在某个阶段接受过家庭护理，护理人员包括全科医生（52%）、社区护士（36.7%）或专业姑息家庭护理人员（17.9%）；27.4%在养老院接受护理，15.7%在专业姑息护理单元接受护理。丧亲家庭成员报告称死者受到工作人员尊严和尊重对待的可能性在养老院（比值比：0.21）和全科医生护理情况下（比值比：0.37）最低。癌症诊断（比值比：2.36）或在家中接受护理（比值比：2.17）会增加丧亲家庭成员报告死者参与护理决策的可能性，而在专业姑息护理单元接受护理时可能性较低（比值比：0.41）。如果在养老院接受护理（比值比：1.85）或死者接受过高等教育（比值比：2.40），关于护理的不必要决策报告的可能性更高。
本研究证实了先前关于临终护理潜在不平等的研究。护理场所和诊断影响了丧亲家庭成员关于死者是否受到尊重和尊严对待以及死者在护理决策中参与程度的报告。
