Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea.
Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
BMC Palliat Care. 2024 Apr 30;23(1):111. doi: 10.1186/s12904-024-01442-2.
In response to the rapid aging population and increasing number of cancer patients, discussions on dignified end-of-life (EoL) decisions are active around the world. Therefore, this study aimed to identify the differences in EoL care patterns between types of hospice used for cancer patients.
In this population-based cohort study, the Korean National Health Insurance Service cohort data containing all registered cancer patients who died between 2017 and 2021 were used. A total of 408,964 individuals were eligible for analysis. The variable of interest, the type of hospice used in the 6 months before death, was classified as follows: (1) Non-hospice users; (2) Hospital-based hospice single users; (3) Home-based hospice single users; (4) Combined hospice users. The outcomes were set as patterns of care, including intense care and supportive care. To identify differences in care patterns between hospice types, a generalized linear model with zero-inflated negative binomial distribution was applied.
Hospice enrollment was associated with less intense care and more supportive care near death. Notably, those who used combined hospice care had the lowest probability and frequency of receiving intense care (aOR: 0.18, 95% CI: 0.17-0.19, aRR: 0.47, 95% CI: 0.44-0.49), while home-based hospice single users had the highest probability and frequency of receiving supportive care (Prescription for narcotic analgesics, aOR: 2.95, 95% CI: 2.69-3.23, aRR: 1.45, 95% CI: 1.41-1.49; Mental health care, aOR: 3.40, 95% CI: 3.13-3.69, aRR: 1.35, 95% CI: 1.31-1.39).
Our findings suggest that although intense care for life-sustaining decreases with hospice enrollment, QoL at the EoL actually improves with appropriate supportive care. This study is meaningful in that it not only offers valuable insight into hospice care for terminally ill patients, but also provides policy implications for the introduction of patient-centered community-based hospice services.
面对人口快速老龄化和癌症患者人数不断增加的局面，全球范围内对有尊严的临终决策展开了热烈讨论。因此，本研究旨在确定用于癌症患者的不同类型临终关怀模式之间的临终关怀护理模式差异。
在这项基于人群的队列研究中，使用了包含 2017 年至 2021 年间所有死亡的癌症患者的韩国国家健康保险服务队列数据。共有 408964 人符合分析条件。本研究的感兴趣变量为死亡前 6 个月内使用的临终关怀类型，分为以下几类：（1）非临终关怀使用者；（2）医院型临终关怀单一使用者；（3）家庭型临终关怀单一使用者；（4）联合临终关怀使用者。结果设定为护理模式，包括强化护理和支持性护理。为了确定临终关怀类型之间护理模式的差异，应用了具有零膨胀负二项分布的广义线性模型。
临终关怀的参与与临终前的强化护理减少和支持性护理增加有关。值得注意的是，使用联合临终关怀护理的患者接受强化护理的概率和频率最低（调整后的优势比：0.18，95%置信区间：0.17-0.19，调整后的相对风险：0.47，95%置信区间：0.44-0.49），而家庭型临终关怀单一使用者接受支持性护理的概率和频率最高（麻醉性镇痛药处方，调整后的优势比：2.95，95%置信区间：2.69-3.23，调整后的相对风险：1.45，95%置信区间：1.41-1.49；心理健康护理，调整后的优势比：3.40，95%置信区间：3.13-3.69，调整后的相对风险：1.35，95%置信区间：1.31-1.39）。
我们的研究结果表明，尽管临终关怀的参与降低了维持生命的强化护理，但适当的支持性护理实际上提高了临终生命质量。本研究具有重要意义，不仅为终末期患者的临终关怀提供了有价值的见解，还为引入以患者为中心的社区为基础的临终关怀服务提供了政策启示。
