Lin Yanxia, Yan Chuchu, Yang Dongliang, Zhang Murong, Gao Haiying, Xie Anqi, Chang Jinwen, Mao Yiwen, Shi Yongxing
School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Public Curriculum Teaching Department, Cangzhou Medical College, Cangzhou, China.
Palliat Med Rep. 2024 Oct 23;5(1):481-491. doi: 10.1089/pmr.2024.0033. eCollection 2024.
Community-based palliative care (CBPC) is only available in large cities in mainland China and little is known about who utilizes it.
This study examined the characteristics, outcomes, and factors associated with place of death (PoD) among inpatient CBPC patients.
This was a multicenter retrospective cohort study.
SETTINGS/SUBJECTS: All patients admitted to the inpatient CBPC unit in four community health centers in 2021 in Shanghai, China, were included.
Characteristics and outcome data were extracted from electronic health records and paper version notes between September 4 and December 29, 2022. PoD was followed up on May 12, 2023. Data were analyzed using descriptive analysis and categorized using two-step clustering. Decision tree analysis was used to identify factors associated with PoD.
The cohort admitted in 2021 included 290 participants (Age: 75.7 ± 12.7 years; Male: = 155, 53.4%) including two children, with a mortality rate of 59.0% and a median length of stay (LoS) of 14 days upon December 29, 2022. The primary diagnosis for 80.3% of participants was tumor. Two clusters were identified. Cluster 1 was smaller than Cluster 2 ( = 45, 15.5% vs. = 245, 84.5%) and dominated by noncancer participants ( = 37, 82.2%), whereas Cluster 2 included 91.8% ( = 225) tumor patients. Greatest significant differences in age, sex, marital status, education level, awareness of diagnosis and/or prognosis, mortality, LoS, and costs were found between the clusters. In total, 265 deaths derived from the cohort upon May 12, 2023, occur in inpatient CBPC units (75.5%), at home (18.9%), and in hospital wards (5.7%), influenced largely by participants' marital status and age.
Establishing contextualized inpatient CBPC services in more places nationwide that are tailored to different characteristics between cancer patients (i.e., younger and shorter inpatient stay) and noncancer patients (i.e., older and longer stay) is essential to maintain that more dying patients remain in their community.
中国大陆只有大城市提供基于社区的姑息治疗（CBPC），对于谁使用这种服务知之甚少。
本研究调查了住院CBPC患者的特征、结局以及与死亡地点（PoD）相关的因素。
这是一项多中心回顾性队列研究。
设置/研究对象：纳入了2021年在中国上海四个社区卫生中心住院CBPC病房收治的所有患者。
从2022年9月4日至12月29日的电子健康记录和纸质病历中提取特征和结局数据。于2023年5月12日对死亡地点进行随访。使用描述性分析进行数据分析，并采用两步聚类法进行分类。采用决策树分析确定与死亡地点相关的因素。
2021年纳入的队列包括290名参与者（年龄：75.7±12.7岁；男性：155名，占53.4%），有两个孩子，截至2022年12月29日死亡率为59.0%，中位住院时间（LoS）为14天。80.3%的参与者主要诊断为肿瘤。识别出两个聚类。聚类1比聚类2小（45名，占15.5%对245名，占84.5%），以非癌症参与者为主（37名，占82.2%），而聚类2包括91.8%（225名）肿瘤患者。两个聚类在年龄、性别、婚姻状况、教育水平、对诊断和/或预后的知晓情况、死亡率、住院时间和费用方面存在最大显著差异。截至2023年5月12日，该队列共有265例死亡，发生在住院CBPC病房（75.5%）、家中（18.9%）和医院病房（5.7%），主要受参与者婚姻状况和年龄影响。
在全国更多地方建立针对癌症患者（即年龄较小、住院时间较短）和非癌症患者（即年龄较大、住院时间较长）不同特征的情境化住院CBPC服务，对于让更多临终患者留在社区至关重要。
