Gitau Kevin, Huang Anjie, Isenberg Sarina R, Stall Nathan, Ailon Jonathan, Bell Chaim M, Quinn Kieran L
Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.
CMAJ Open. 2023 Nov 7;11(6):E1025-E1032. doi: 10.9778/cmajo.20220232. Print 2023 Nov-Dec.
It is unclear whether there are sex-based differences in use of palliative care near the end of life. The objective of this study was to measure the association between sex and palliative care use.
We performed a population-based retrospective cohort study of all patients aged 18 years or older in the last year of life who died in Ontario, Canada, between 2010 and 2018. The primary exposure was patient biologic sex (male or female). The primary outcome was receipt of physician-delivered palliative care; secondary outcomes were approach to in-hospital palliative care and sex concordance of the patient and referring physician. We used multivariable modified Poisson regression to measure the association between patient sex and palliative care receipt, as well as patient-physician sex concordance.
There were 706 722 patients (354 657 females [50.2%], median age 80 yr [interquartile range 69-87 yr]) in the study cohort, 377 498 (53.4%) of whom received physician-delivered palliative care. After adjustment for age and selected comorbidities, female sex was associated with a 9% relative increase (adjusted relative risk [RR] 1.09, 95% CI 1.08-1.10) in receipt of physician-delivered palliative care. Female patients were 16% more likely than male patients (adjusted RR 1.14, 95% CI 1.14-1.18) to have had their first hospital admission in their final year of life categorized as having a likely palliative intent. Female patients were 18% more likely than male patients (RR 1.18, 95% CI 1.17-1.19) to have had a female referring physician, and male patients were 20% more likely than female patients (adjusted RR 1.20, CI 1.19-1.21) to have had a male referring physician.
After adjustment for age and comorbidities, male patients were slightly less likely than female patients to have received physician-delivered palliative care, and female patients were more likely than male patients to have had their first hospital admission in their final year of life categorized as having a likely palliative care intent. These results may reflect a between-sex difference in overall end-of-life care preferences or sex differences in decision-making influenced by patient-specific factors; further studies exploring how these factors affect end-of-life decision-making are required.
临终时姑息治疗的使用是否存在性别差异尚不清楚。本研究的目的是衡量性别与姑息治疗使用之间的关联。
我们对2010年至2018年期间在加拿大安大略省死亡的所有18岁及以上生命最后一年的患者进行了一项基于人群的回顾性队列研究。主要暴露因素是患者的生物学性别（男性或女性）。主要结局是接受医生提供的姑息治疗；次要结局是住院姑息治疗的方式以及患者与转诊医生的性别一致性。我们使用多变量修正泊松回归来衡量患者性别与接受姑息治疗之间的关联，以及患者与医生的性别一致性。
研究队列中有706722名患者（354657名女性[50.2%]，中位年龄80岁[四分位间距69 - 87岁]）其中377498名（53.4%）接受了医生提供的姑息治疗。在调整年龄和选定的合并症后，女性性别与接受医生提供的姑息治疗的相对增加9%相关（调整后的相对风险[RR]1.09，95%CI 1.08 - 1.10）。女性患者在生命最后一年首次住院被归类为可能具有姑息治疗意图的可能性比男性患者高16%（调整后的RR 1.14，95%CI 1.14 - 1.18）。女性患者有女性转诊医生的可能性比男性患者高18%（RR 1.18，95%CI 1.17 - 1.19），男性患者有男性转诊医生的可能性比女性患者高20%（调整后的RR 1.20，CI 1.19 - 1.21）。
在调整年龄和合并症后，男性患者接受医生提供的姑息治疗的可能性略低于女性患者，并且女性患者在生命最后一年首次住院被归类为可能具有姑息治疗意图的可能性比男性患者更高。这些结果可能反映了总体临终护理偏好方面的性别差异或受患者特定因素影响的决策中的性别差异；需要进一步研究探索这些因素如何影响临终决策。
