Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Family Medicine, Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada.
PLoS One. 2021 Jun 15;16(6):e0252814. doi: 10.1371/journal.pone.0252814. eCollection 2021.
The end-of-life symptom prevalence of non-cancer patients have been described mostly in hospital and institutional settings. This study aims to describe the average symptom trajectories among non-cancer patients who are community-dwelling and used home care services at the end of life.
This is a retrospective, population-based cohort study of non-cancer patients who used home care services in the last 6 months of life in Ontario, Canada, between 2007 and 2014. We linked the Resident Assessment Instrument for Home Care (RAI-HC) (standardized home care assessment tool) and the Discharge Abstract Databases (for hospital deaths). Patients were grouped into four non-cancer disease groups: cardiovascular, neurological, respiratory, and renal (not mutually exclusive). Our outcomes were the average prevalence of these outcomes, each week, across the last 6 months of life: uncontrolled moderate-severe pain as per the Pain Scale, presence of shortness of breath, mild-severe cognitive impairment as per the Cognitive Performance Scale, and presence of caregiver distress. We conducted a multivariate logistic regression to identify factors associated with having each outcome respectively, in the last 6 months.
A total of 20,773 non-cancer patient were included in our study, which were analyzed by disease groups: cardiovascular (n = 12,923); neurological (n = 6,935); respiratory (n = 6,357); and renal (n = 3,062). Roughly 80% of patients were > 75 years and half were female. In the last 6 months of life, moderate to severe pain was frequent in the cardiovascular (57.2%), neurological (42.7%), renal (61.0%) and respiratory (58.3%) patients. Patients with renal disease had significantly higher odds for reporting uncontrolled moderate to severe pain (odds ratio [OR] = 1.21; 95% CI: 1.08 to 1.34) than those who did not. Patients with respiratory disease reported significantly higher odds for shortness of breath (5.37; 95% CI, 5.00 to 5.80) versus those who did not. Patients with neurological disease compared to those without were 9.65 times more likely to experience impaired cognitive performance and had 56% higher odds of caregiver distress (OR = 1.56; 95% CI: 1.43 to 1.71).
In our cohort of non-cancer patients dying in the community, pain, shortness of breath, impaired cognitive function and caregiver distress are important symptoms to manage near the end of life even in non-institutional settings.
非癌症患者临终症状的流行情况主要在医院和机构环境中描述。本研究旨在描述在加拿大安大略省，2007 年至 2014 年间，在生命的最后 6 个月内使用家庭护理服务的社区居住的非癌症患者的平均症状轨迹。
这是一项回顾性、基于人群的非癌症患者队列研究，这些患者在加拿大安大略省，2007 年至 2014 年间，在生命的最后 6 个月内使用家庭护理服务。我们将居民评估工具（用于家庭护理）（标准化家庭护理评估工具）和出院摘要数据库（用于医院死亡）联系起来。患者被分为四类非癌症疾病组：心血管疾病、神经疾病、呼吸疾病和肾脏疾病（不相互排斥）。我们的结局是在生命的最后 6 个月里，每周这些结局的平均发生率：根据疼痛量表，未控制的中度至重度疼痛；呼吸短促的存在；根据认知表现量表，轻度至重度认知障碍；以及照顾者的痛苦。我们进行了多变量逻辑回归分析，以确定在生命的最后 6 个月内，分别与每个结局相关的因素。
共有 20773 名非癌症患者被纳入我们的研究，根据疾病组进行分析：心血管疾病（n = 12923）；神经疾病（n = 6935）；呼吸疾病（n = 6357）；和肾脏疾病（n = 3062）。大约 80%的患者年龄大于 75 岁，一半是女性。在生命的最后 6 个月里，心血管疾病（42.7%）、神经疾病（61.0%）、肾脏疾病（58.3%）和呼吸疾病（57.2%）患者的中重度疼痛较为常见。患有肾脏疾病的患者报告未控制的中重度疼痛的可能性显著高于未患有肾脏疾病的患者（比值比[OR] = 1.21；95%置信区间：1.08 至 1.34）。患有呼吸疾病的患者报告呼吸急促的可能性显著高于未患有呼吸疾病的患者（5.37；95%置信区间，5.00 至 5.80）。与未患有神经疾病的患者相比，患有神经疾病的患者发生认知功能障碍的可能性高出 9.65 倍，且照顾者痛苦的可能性高出 56%（OR = 1.56；95%置信区间：1.43 至 1.71）。
在我们的社区死亡的非癌症患者队列中，疼痛、呼吸急促、认知功能障碍和照顾者痛苦是生命末期即使在非机构环境中也需要管理的重要症状。
