Department of biomedicine and prevention, University of Rome "Tor Vergata", Rome, Italy.
Department of Palliative Care and Pain Therapy Unit, Azienda ULSS n.4 Veneto Orientale, San Donà di Piave, Italy.
Acta Biomed. 2022 May 12;93(S2):e2022189. doi: 10.23750/abm.v93iS2.12637.
Place of death and disenrollment from specialized palliative care services (SPCSs) are two aspects that determine service utilization. These aspects should be determined by patient needs and preferences, but they are often associated to patient sociodemographic or contextual characteristics. The aim of this study was to describe which factors are associated with utilizing SPCSs in terms of place of death and disenrollment.
Retrospective cohort study. Patients (>18 years) who died or were disenrolled during SPCSs utilization. Two hierarchical regression models were performed, and variables were categorized in predisposing, enabling, and need factors according to the Andersen behavioral model of health services use.
We included 35,869 patients (52,5% male, mean age 74,6 ± 12,3 SD), where 17,225 patients died in hospice and 16,953 at home, while 1,691 patients were disenrolled. Dying at home was associated with older age, oncological diagnosis, painful symptoms and longer survival time. Instead, service disenrollment was associated with less education, longer wait time and longer length of stay.
SPCS utilization was not influenced only by patient need, but also by other factors, such as social and contextual factors. These factors need to be considered by health care providers and efforts are needed for 1) identifying barriers and implementing effective interventions to support patients and caregivers in their preferred place of care and death and 2) for avoiding SPCS disenrollment with an increased probability of aggressive treatments and worse quality of life for patients.
死亡地点和退出专门的姑息治疗服务（SPCs）是决定服务利用的两个方面。这些方面应该根据患者的需求和偏好来确定，但它们通常与患者的社会人口统计学或背景特征有关。本研究的目的是描述哪些因素与 SPCs 的利用有关，包括死亡地点和退出服务。
回顾性队列研究。在 SPCs 利用期间死亡或退出的患者（>18 岁）。进行了两次层次回归模型分析，并根据安德森卫生服务利用行为模型，将变量分为倾向因素、促成因素和需要因素。
我们纳入了 35869 名患者（52.5%为男性，平均年龄 74.6±12.3 岁），其中 17225 名患者在临终关怀中死亡，16953 名在家中死亡，1691 名患者退出服务。在家中死亡与年龄较大、肿瘤诊断、疼痛症状和较长的生存时间有关。相反，服务退出与受教育程度较低、等待时间较长和住院时间较长有关。
SPCS 的利用不仅受到患者需求的影响，还受到其他因素的影响，如社会和背景因素。这些因素需要由医疗保健提供者考虑，并需要努力：1）确定障碍并实施有效的干预措施，以支持患者和护理人员在其首选的护理和死亡地点；2）避免 SPCS 退出，因为这会增加患者接受积极治疗的可能性，并降低其生活质量。
