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成人癌症晚期患者临终关怀中的过度治疗问题:应用全国性登记处的质量指标。

Potential overtreatment in end-of-life care in adults 65 years or older dying from cancer: applying quality indicators on nationwide registries.

机构信息

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden.

出版信息

Acta Oncol. 2022 Dec;61(12):1437-1445. doi: 10.1080/0284186X.2022.2153621. Epub 2022 Dec 10.


DOI:10.1080/0284186X.2022.2153621
PMID:36495144
Abstract

BACKGROUND: Quality indicators are frequently used to measure the quality of care at the end of life. Whether quality indicators of potential (i.e., when the risks outweigh the benefits) at the end of life can be reliably applied to routinely collected data remains uncertain. This study aimed to identify quality indicators of overtreatment at the end of life in the published literature and to investigate their tentative prevalence among older adults dying with solid cancer. MATERIALS AND METHODS: Retrospective cohort study of decedents including all older adults (≥65 years) who died with solid cancer between 1 January 2013 and 31 December 2015 ( = 54,177) in Sweden. Individual data from the National Cause of Death Register were linked with data from the Total Population Register, the National Patient Register, and the Swedish Prescribed Drug Register. Quality indicators were applied for the last one and three months of life. RESULTS: From a total of 145 quality indicators of overtreatment identified in the literature, 82 (57%) were potentially operationalisable with routine administrative and healthcare data in Sweden. Unidentifiable procedures and hospital drug treatments were the reason for non-operationalisability in 52% of the excluded indicators. Among the 82 operationalisable indicators, 67 measured overlapping concepts. Based on the remaining 15 unique indicators, we tentatively estimated that overall, about one-third of decedents received at least one treatment or procedure indicative of 'potential overtreatment' during their last month of life. CONCLUSION: Almost half of the published overtreatment indicators could not be measured in routine administrative and healthcare data in Sweden due to a lack of means to capture the care procedure. Our tentative estimates suggest that potential overtreatment might affect one-third of cancer decedents near death. However, quality indicators of potential overtreatment for specific use in routinely collected data should be developed and validated.

摘要

背景:质量指标常用于衡量生命末期的医疗保健质量。生命末期潜在过度治疗(即风险大于收益时)的质量指标是否可以可靠地应用于常规收集的数据尚不确定。本研究旨在确定生命末期过度治疗的质量指标,并调查其在患有实体瘤的老年死亡患者中的暂定患病率。

材料和方法:回顾性队列研究包括所有在 2013 年 1 月 1 日至 2015 年 12 月 31 日期间死于实体瘤的老年患者(≥65 岁)(n=54177)。来自国家死因登记处的个人数据与总人口登记处、国家患者登记处和瑞典处方药物登记处的数据相关联。质量指标适用于生命的最后一个月和三个月。

结果:在文献中确定的 145 种过度治疗的质量指标中,82 种(57%)在瑞典使用常规行政和医疗保健数据具有潜在可操作性。无法识别的程序和医院药物治疗是 52%被排除指标不可操作性的原因。在 82 个可操作的指标中,有 67 个指标测量的是重叠概念。基于其余 15 个独特指标,我们暂定估计,在生命的最后一个月,大约有三分之一的死者接受了至少一种治疗或程序,表明存在“潜在过度治疗”。

结论:由于缺乏捕捉护理程序的手段,瑞典近一半的已发表过度治疗指标无法在常规行政和医疗保健数据中进行测量。我们的暂定估计表明,潜在的过度治疗可能会影响三分之一的癌症临终患者。然而,应开发和验证针对特定常规收集数据使用的潜在过度治疗质量指标。

相似文献

[1]
Potential overtreatment in end-of-life care in adults 65 years or older dying from cancer: applying quality indicators on nationwide registries.

Acta Oncol. 2022-12

[2]
How many older adults receive drugs of questionable clinical benefit near the end of life? A cohort study.

Palliat Med. 2019-6-7

[3]
Resource use, costs and quality of end-of-life care: observations in a cohort of elderly Australian cancer decedents.

Implement Sci. 2015-2-26

[4]
Evaluation of quality indicators near death in older adult cancer decedents in Japan: A nationwide retrospective cohort study.

Jpn J Clin Oncol. 2021-11-1

[5]
Evaluating quality of care at the end of life and setting best practice performance standards: a population-based observational study using linked routinely collected administrative databases.

BMC Palliat Care. 2022-4-12

[6]
Better quality of end-of-life care for persons with advanced dementia in nursing homes compared to hospitals: a Swedish national register study.

BMC Palliat Care. 2020-8-26

[7]
Quality of end-of-life care in patients with dementia compared to patients with cancer: A population-based register study.

PLoS One. 2018-7-30

[8]
Old age as risk indicator for poor end-of-life care quality - a population-based study of cancer deaths from the Swedish Register of Palliative Care.

Eur J Cancer. 2015-5-6

[9]
Unequal care for dying patients in Sweden: a comparative registry study of deaths from heart disease and cancer.

Eur J Cardiovasc Nurs. 2012-4-4

[10]
End-of-life care among older cancer patients with intellectual disability in comparison with the general population: a national register study.

J Intellect Disabil Res. 2020-5

引用本文的文献

[1]
Influence of palliative care policy on place of death for people with different cancer types: a nationwide' register study.

PLoS One. 2025-3-27

[2]
A taxonomy of the factors contributing to the overtreatment of cancer patients at the end of life. What is the problem? Why does it happen? How can it be addressed?

ESMO Open. 2025-1

[3]
Endocrine treatment near the end of life among older women with metastatic breast cancer: a nationwide cohort study.

Front Oncol. 2023-10-9

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