Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia.
Clinical Research Centre, Sunway Medical Centre, Selangor, Malaysia.
Am J Hosp Palliat Care. 2022 Jul;39(7):762-771. doi: 10.1177/10499091211048767. Epub 2021 Oct 17.
Achievement of patients' preferred place of death is recognized as a component of a good death. This study aimed to investigate the symptom burden in advanced cancer patients, achievement of their place of death preferences and factors associated with home death.
In this retrospective review of 287 patient deaths, we examined patients' symptom prevalence, preferred and actual place of death and achievement of their place of death preferences using descriptive statistics. Associations between patient factors, home death preference and actual home death were further analyzed using multivariate logistic regression.
The most prevalent symptoms were weakness, pain and poor appetite, with a mean of 5.77(SD: 2.37) symptoms per patient. The median interval from palliative care referral to death was 21 (IQR: 74) days. Of the 253 patients with documented place of death preference, 132 (52.1%) preferred home death, 111(43.9%) preferred hospital death, 1 (0.4%) preferred to die at a temple and 9(3.6%) expressed no preference. Overall, 221 of 241(91.7%) patients with known actual place of death achieved their preference. Older patients were more likely to prefer home death (OR 1.021; 95% CI 1.004-1.039, p = 0.018) and die at home (OR 1.023; 95% CI 1.005-1.041, p = 0.014). Gender, marital status, cancer diagnosis and symptoms were not associated with preference for or actual home death.
Despite a high symptom burden, most patients preferred and achieved a home death. Late palliative care referral and difficult symptom management contributed to failure to fulfill home death preference. Preference for home death should be considered when managing terminally ill geriatric patients.
实现患者首选的死亡地点被认为是善终的一个组成部分。本研究旨在调查晚期癌症患者的症状负担，以及他们对死亡地点偏好的实现情况，并分析与在家中死亡相关的因素。
在这项对 287 例患者死亡的回顾性研究中，我们使用描述性统计方法检查了患者的症状发生率、首选和实际死亡地点以及他们对死亡地点偏好的实现情况。进一步使用多变量逻辑回归分析了患者因素、在家中死亡偏好与实际在家中死亡之间的关联。
最常见的症状是虚弱、疼痛和食欲不振，每位患者平均有 5.77（SD：2.37）种症状。从姑息治疗转介到死亡的中位时间为 21（IQR：74）天。在有记录的死亡地点偏好的 253 名患者中，132 名（52.1%）首选在家中死亡，111 名（43.9%）首选在医院死亡，1 名（0.4%）首选在寺庙中死亡，9 名（3.6%）表示没有偏好。总的来说，241 名已知实际死亡地点的患者中有 221 名（91.7%）实现了他们的偏好。年龄较大的患者更有可能选择在家中死亡（OR 1.021；95%CI 1.004-1.039，p = 0.018）并在家中死亡（OR 1.023；95%CI 1.005-1.041，p = 0.014）。性别、婚姻状况、癌症诊断和症状与在家中死亡偏好或实际死亡无关。
尽管存在较高的症状负担，但大多数患者首选并实现了在家中死亡。姑息治疗的延迟转介和难以控制的症状管理导致无法满足在家中死亡的偏好。在管理晚期老年患者时，应考虑在家中死亡的偏好。
