Chiang Jui-Kun, Kao Yee-Hsin
Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi.
Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.
Medicine (Baltimore). 2021 May 7;100(18):e25841. doi: 10.1097/MD.0000000000025841.
Palliative care has improved quality of end-of-life (EOL) care for patients with cancer, and these benefits may be extended to patients with other serious illnesses. EOL care quality for patients with home-based care is a critical problem for health care providers. We compare EOL quality care between patients with advanced illnesses receiving home-based care with and without palliative services.The medical records of deceased patients who received home-based care at a community teaching hospital in south Taiwan from January to December 2019 were collected retrospectively. We analyzed EOL care quality indicators during the last month of life.A total of 164 patients were included for analysis. Fifty-two (31.7%) received palliative services (HP group), and 112 (68.3%) did not receive palliative services (non-HP group). Regarding the quality indicators of EOL care, we discovered that a lower percentage of the HP group died in a hospital than did that of the non-HP group (34.6% vs 62.5%, P = .001) through univariate analysis. We found that the HP group had lower scores on the aggressiveness of EOL care than did the non-HP group (0.5 ± 0.9 vs 1.0 ± 1.0, P<.001). Furthermore, palliative services were a significant and negative factor of dying in a hospital after adjustment (OR = 0.13, 95%CI = 0.05-0.36, P < .001).For patients with advanced illnesses receiving home-based care, palliative services are associated with lower scores on the aggressiveness of EOL care and a reduced probability of dying in a hospital.
姑息治疗改善了癌症患者的临终（EOL）护理质量，这些益处可能也适用于其他重病患者。对于医疗服务提供者而言，居家护理患者的临终护理质量是一个关键问题。我们比较了接受和未接受姑息治疗服务的晚期疾病居家护理患者的临终护理质量。回顾性收集了2019年1月至12月在台湾南部一家社区教学医院接受居家护理的已故患者的病历。我们分析了患者生命最后一个月的临终护理质量指标。共有164例患者纳入分析。52例（31.7%）接受了姑息治疗服务（HP组），112例（68.3%）未接受姑息治疗服务（非HP组）。关于临终护理的质量指标，通过单因素分析我们发现，HP组在医院死亡的比例低于非HP组（34.6%对62.5%，P = 0.001）。我们发现，HP组在临终护理的激进程度方面得分低于非HP组（0.5±0.9对1.0±1.0，P<0.001）。此外，调整后姑息治疗服务是在医院死亡的一个显著负性因素（OR = 0.13，95%CI = 0.05 - 0.36，P < 0.001）。对于接受居家护理的晚期疾病患者，姑息治疗服务与较低的临终护理激进程度得分以及在医院死亡概率降低相关。
