Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
Maridulu Budyari Gumal - Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), UNSW, Sydney, Australia.
BMC Palliat Care. 2024 Feb 2;23(1):32. doi: 10.1186/s12904-024-01358-x.
Variation persists in the quality of end-of-life-care (EOLC) for people with cancer. This study aims to describe the characteristics of, and examine factors associated with, indicators of potentially burdensome care provided in hospital, and use of hospital services in the last 12 months of life for people who had a death from cancer.
A population-based retrospective cohort study of people aged ≥ 20 years who died with a cancer-related cause of death during 2014-2019 in New South Wales, Australia using linked hospital, cancer registry and mortality records. Ten indicators of potentially burdensome care were examined. Multinominal logistic regression examined predictors of a composite measure of potentially burdensome care, consisting of > 1 ED presentation or > 1 hospital admission or ≥ 1 ICU admission within 30 days of death, or died in acute care.
Of the 80,005 cancer-related deaths, 86.9% were hospitalised in the 12 months prior to death. Fifteen percent had > 1 ED presentation, 9.9% had > 1 hospital admission, 8.6% spent ≥ 14 days in hospital, 3.6% had ≥ 1 intensive care unit admission, and 1.2% received mechanical ventilation on ≥ 1 occasion in the last 30 days of life. Seventeen percent died in acute care. The potentially burdensome care composite measure identified 20.0% had 1 indicator, and 10.9% had ≥ 2 indicators of potentially burdensome care. Compared to having no indicators of potentially burdensome care, people who smoked, lived in rural areas, were most socially economically disadvantaged, and had their last admission in a private hospital were more likely to experience potentially burdensome care. Older people (≥ 55 years), females, people with 1 or ≥ 2 Charlson comorbidities, people with neurological cancers, and people who died in 2018-2019 were less likely to experience potentially burdensome care. Compared to people with head and neck cancer, people with all cancer types (except breast and neurological) were more likely to experience ≥ 2 indicators of potentially burdensome care versus none.
This study shows the challenge of delivering health services at end-of-life. Opportunities to address potentially burdensome EOLC could involve taking a person-centric approach to integrate oncology and palliative care around individual needs and preferences.
癌症患者的临终关怀质量存在差异。本研究旨在描述在生命的最后 12 个月内，在医院接受潜在负担过重的治疗和使用医院服务的特征，并探讨与这些治疗相关的因素，这些治疗与癌症患者的死亡有关。
本研究采用回顾性队列研究，对 2014 年至 2019 年期间在澳大利亚新南威尔士州因癌症相关原因死亡的年龄≥20 岁的人群进行了研究，研究数据来自于医院、癌症登记处和死亡率记录的链接。共检查了 10 种潜在负担过重的治疗指标。多分类逻辑回归分析了潜在负担过重治疗综合指标的预测因素，该综合指标包括在死亡前 30 天内≥1 次急诊就诊或≥1 次住院或≥1 次重症监护病房就诊，或死于急性护理。
在 80005 例癌症相关死亡中，86.9%的患者在死亡前 12 个月内住院治疗。15%的患者有≥1 次急诊就诊，9.9%的患者有≥1 次住院，8.6%的患者住院时间≥14 天，3.6%的患者有≥1 次重症监护病房就诊，1.2%的患者在生命的最后 30 天内有≥1 次机械通气。17%的患者死于急性护理。潜在负担过重的治疗综合指标显示，有 20.0%的患者有 1 个指标，10.9%的患者有≥2 个潜在负担过重的治疗指标。与没有潜在负担过重的治疗指标相比，吸烟、居住在农村地区、社会经济地位最低、最后一次入院在私立医院的患者更有可能经历潜在负担过重的治疗。年龄较大（≥55 岁）、女性、有 1 个或≥2 个 Charlson 合并症、患有神经癌、以及在 2018-2019 年死亡的患者不太可能经历潜在负担过重的治疗。与头颈部癌症患者相比，所有癌症类型（除乳腺癌和神经癌外）的患者更有可能经历≥2 个潜在负担过重的治疗指标，而非没有。
本研究表明，在生命末期提供医疗服务存在挑战。解决潜在负担过重的临终关怀问题的机会可能包括采取以人为本的方法，根据个人的需求和偏好，整合肿瘤学和姑息治疗。
