Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
BMC Health Serv Res. 2023 Oct 31;23(1):1184. doi: 10.1186/s12913-023-10228-w.
Many people living with cancer are admitted as an emergency, some just prior to diagnosis and others in their last year of life. Factors associated with accessing emergency care for people dying of cancer are complex and not well understood. This can make it difficult to have the resources and staffing in place to best care for individuals in their last year of life and their families.
This study uses routinely collected administrative data from people who died of cancer in N. Ireland (NI) during 2015 and explores how personal characteristics (e.g., gender, age) and disease related factors (e.g., tumour site, cancer stage at initial diagnosis) were associated with having an emergency admission to hospital in the last year and the last 28 days of their lives, using multivariate logistic regression.
Almost three in four people had at least one emergency admission in the last year of life, and over one in three had an emergency admission the last 28 days of life. Patterns were similar for both time outcomes with males, people with haematological, lung or brain cancers, younger persons, those diagnosed with late-stage cancer, and people diagnosed close to time of death, being significantly more likely to have an emergency admission. While there was no significant association between deprivation and emergency admission rates, those living in urban areas were more likely to have an emergency admission in their last month of life compared to rural dwellers. Late diagnosis was evident with 538 people (12.8% of all deaths from cancer) being diagnosed within one month of death and 1242 (29%) within 3 months of death.
The high level of emergency admissions points to gaps in routine end-of-life care, and the need for additional training for hospital staff including frontline emergency department (ED) staff who are often the 'gatekeepers' to emergency inpatient care for people living with cancer. The levels of late diagnosis indicate a need for increased population awareness of cancer symptoms and system change to promote earlier diagnosis.
许多癌症患者以急症入院，有些是在确诊前，有些则是在生命的最后一年。与癌症晚期患者寻求紧急护理相关的因素复杂且尚未得到充分理解。这使得难以在生命的最后一年为患者及其家属提供所需的资源和人员配置。
本研究使用北爱尔兰（NI）2015 年死于癌症的人群的常规收集的行政数据，利用多变量逻辑回归，探讨个人特征（如性别、年龄）和疾病相关因素（如肿瘤部位、初始诊断时的癌症分期）与在生命的最后一年和最后 28 天住院接受急诊治疗之间的关系。
近四分之三的人在生命的最后一年至少有一次急诊入院，超过三分之一的人在生命的最后 28 天有急诊入院。这两种时间结果的模式相似，男性、患有血液、肺部或脑部癌症的人、年轻人、被诊断为晚期癌症的人以及接近死亡时间被诊断的人，更有可能接受急诊入院。虽然贫困与急诊入院率之间没有显著关联，但居住在城市地区的人比居住在农村地区的人更有可能在生命的最后一个月接受急诊入院。晚期诊断很明显，有 538 人（所有癌症死亡人数的 12.8%）在死亡前一个月内被诊断，1242 人（29%）在死亡前三个月内被诊断。
急诊入院率居高不下，表明常规临终关怀存在差距，需要对医院工作人员进行额外培训，包括急诊部（ED）一线工作人员，他们通常是癌症患者接受急诊住院治疗的“把关人”。晚期诊断的程度表明需要提高公众对癌症症状的认识，并进行系统变革以促进早期诊断。
