Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada.
Institute for Clinical Evaluative Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada.
Curr Oncol. 2021 Nov 12;28(6):4673-4685. doi: 10.3390/curroncol28060394.
This retrospective cohort study of cancer decedents during 2004-2015 examined end-of-life cancer care quality indicators (QIs) in the provinces of British Columbia (BC), Ontario, and Nova Scotia (NS). These included: emergency department use, in-patient hospitalization, intensive care unit admissions, physician house calls, home care visits, and death experienced in hospital. Ontario saw the greatest 12-year decrease in in-hospital deaths from 52.8% to 41.1%. Hospitalization rates within 30 days of death decreased in Ontario, increased in NS, and remained the same in BC. Ontario's usage of aggressive end-of-life measures changed very little, while BC increased their utilization rates. Supportive care use increased in both NS and Ontario. Those who were male or living in a lower income/smaller community (in Ontario) were associated with a decreased likelihood of receiving supportive care. Despite the shift in focus to providing hospice and home care services, approximately 50% of oncology patients are still dying in hospital and 11.7% of patients overall are subject to aggressive care measures that may be out of line with their desire for comfort care. Supportive care use is increasing, but providers must ensure that Canadians are connected to palliative services, as its utilization improves a wide variety of outcomes.
这项回顾性队列研究在 2004 年至 2015 年期间对癌症死亡患者进行了研究，考察了不列颠哥伦比亚省（BC）、安大略省和新斯科舍省（NS）的临终癌症护理质量指标（QIs）。这些指标包括：急诊使用、住院、重症监护病房入院、医生家访、家庭护理访问以及在医院死亡。安大略省的住院死亡人数在 12 年内从 52.8%下降到 41.1%。安大略省在死亡后 30 天内的住院率下降，NS 省增加，BC 省保持不变。安大略省的激进临终措施使用变化不大，而 BC 省则增加了使用率。男性或居住在收入较低/较小社区（在安大略省）的患者接受支持性护理的可能性降低。尽管关注重点已转向提供临终关怀和家庭护理服务，但仍有约 50%的肿瘤患者在医院死亡，约 11.7%的患者接受可能不符合他们舒适护理意愿的激进治疗措施。支持性护理的使用正在增加，但提供者必须确保加拿大患者能够获得姑息治疗服务，因为其使用的增加改善了各种结果。
