Research and training department, Iranian Cancer Control Center (MACSA) - Isfahan branch, Isfahan, Iran.
Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, HezarJarib Ave, P.O. Box 319, Isfahan, Iran.
BMC Palliat Care. 2024 Sep 4;23(1):220. doi: 10.1186/s12904-024-01550-z.
While home is frequently expressed as the favorite place of death (PoD) among terminally ill cancer patients, various factors affect the fulfillment of this wish. The determinants of the PoD of cancer patients in countries without healthcare system-integrated palliative and supportive care have not been studied before. This study aimed at identifying the predictors of the PoD of patients who suffer from advanced cancer by developing a reliable predictive model among who received home-based palliative care in Iran as a representative of the countries with isolated provision of palliative care services.
In a cross-sectional study, electronic records of 4083 advanced cancer patients enrolled in the Iranian Cancer Control Center (MACSA) palliative homecare program, who died between February 2018 and February 2020 were retrieved. Multivariable binary logistic regression analysis as well as subgroup analyses (location, sex, marital status, and tumor topography) was performed to identify the predictors of PoD.
Of the 2398 cases included (mean age (SD) = 64.17 (14.45) year, 1269 (%52.9) male), 1216 (50.7%) patients died at home. Older age, presence and intensity of medical homecare in the last two weeks and registration in the Tehran site of the program were associated with dying at home (P < 0.05). Gynecological or hematological cancers, presence and intensity of the calls received from the remote palliative care unit in the last two weeks were predictors of death at the hospital (p < 0.05). The model was internally and externally validated (AUC = 0.723 (95% CI = 0.702-0.745; P < 0.001) and AUC = 0.697 (95% CI = 0.631-0.763; P < 0.001) respectively).
Our model highlights the demographic, illness-related and environmental determinants of the PoD in communities with patchy provision of palliative care. It also urges policymakers and service providers to identify and take the local determinant of the place of death into account to match the goals of palliative and supportive services with the patient preferences.
尽管临终癌症患者经常将家表述为他们最喜爱的死亡地点（PoD），但各种因素会影响这一愿望的实现。在没有将姑息治疗和支持性护理纳入医疗保健系统的国家，癌症患者 PoD 的决定因素此前尚未得到研究。本研究旨在通过在伊朗开发一个可靠的预测模型，来确定在家接受姑息治疗的晚期癌症患者的 PoD 预测因素，伊朗作为提供孤立姑息治疗服务的国家的代表。
在一项横断面研究中，检索了 2018 年 2 月至 2020 年 2 月期间在伊朗癌症控制中心（MACSA）姑息治疗家庭护理计划中登记并死亡的 4083 名晚期癌症患者的电子记录。采用多变量二项逻辑回归分析以及亚组分析（地点、性别、婚姻状况和肿瘤位置）来确定 PoD 的预测因素。
在纳入的 2398 例病例中（平均年龄（标准差）=64.17（14.45）岁，男性 1269 例[52.9%]），有 1216 例（50.7%）患者在家中死亡。年龄较大、临终前两周有医疗家访且强度较高、以及在该计划的德黑兰站点登记，与在家中死亡相关（P<0.05）。妇科或血液系统癌症、临终前两周从远程姑息治疗单位收到的电话数量和强度是在医院死亡的预测因素（p<0.05）。该模型进行了内部和外部验证（AUC=0.723（95%CI=0.702-0.745；P<0.001）和 AUC=0.697（95%CI=0.631-0.763；P<0.001））。
本研究模型强调了在姑息治疗服务提供不充分的社区中，人口统计学、疾病相关和环境决定因素对 PoD 的影响。它还敦促决策者和服务提供者确定并考虑当地的死亡地点决定因素，以将姑息和支持性服务的目标与患者的偏好相匹配。
