Kilpatrick Kelley, Allard Émilie, Jabbour Mira, Tchouaket Eric
Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital Site, Montreal, QC, Canada.
BMC Palliat Care. 2025 Jul 12;24(1):197. doi: 10.1186/s12904-025-01840-0.
Significant knowledge gaps persist in understanding how to support patients receiving palliative and end-of-life care (PEoLC) who wish to die at home. This study aimed to identify factors associated with remaining at home and home death for patients receiving PEoLC.
A sequential mixed-methods explanatory study (QUANT + QUAL) was conducted. Administrative data from a not-for-profit at-home palliative care organization in Québec Canada from 2015 to 2024 (n = 5931) and 73 semi-structured interviews with patients receiving PEoLC, caregivers, service providers and decision-makers were collected. Logistic and Cox regression models were completed for the quantitative data analysis. Content analysis was used for the qualitative data analysis. Data integration occurred following the quantitative analyses.
The mean age of patients requiring PEoLC was 77.97 (SD: 13.70) years. The sample included 50.3% men and 49.7% women. One quarter (25.8%) of patients receiving PEoLC lived alone. Most patients (93.5%) had cancer. Home death occurred in almost 30% of cases. Over 95% of deaths occurred within 365 days following admission to the at-home palliative care organization. Access to respite care (adjusted odds ratio: 2.699, p < 0.001), female sex, living alone, having been hospitalized, receiving psychological care, and volunteer and transportation support were associated with remaining at home and home deaths for patients receiving PEoLC. The interviews highlighted the importance of respecting the patients' wishes related to end of life and home death. All participants described several challenges to access timely and reliable services following the pandemic. Timely access to home care, nursing and hygiene and a palliative care approach facilitated remaining at home and home death for patients receiving PEoLC.
Respite care more than doubles the odds of remaining at home and home death. Timely access to services that include home care, nursing care and hygiene and a palliative care approach is essential to support patients receiving PEoLC who wish to die at home. Stabilizing staffing of home care teams, standardizing PEoLC services offered across community health centers in the province, and optimal use of nurse practitioners would improve services offered to patients receiving PEoLC and their caregivers.
在如何支持希望在家中离世的接受姑息治疗和临终关怀（PEoLC）的患者方面，仍存在重大知识空白。本研究旨在确定与接受PEoLC的患者在家中离世及在家中去世相关的因素。
开展了一项序列混合方法解释性研究（定量+定性）。收集了加拿大魁北克一个非营利性居家姑息治疗组织2015年至2024年的行政数据（n = 5931），并对接受PEoLC的患者、护理人员、服务提供者和决策者进行了73次半结构化访谈。对定量数据分析采用逻辑回归和Cox回归模型。定性数据分析采用内容分析法。定量分析后进行数据整合。
需要PEoLC的患者平均年龄为77.97岁（标准差：13.70）。样本中男性占50.3%，女性占49.7%。接受PEoLC的患者中有四分之一（25.8%）独居。大多数患者（93.5%）患有癌症。近30%的病例在家中去世。超过95%的死亡发生在进入居家姑息治疗组织后的365天内。获得喘息护理（调整后的优势比：2.699，p < 0.001）、女性、独居、曾住院、接受心理护理以及志愿者和交通支持与接受PEoLC的患者在家中离世及在家中去世相关。访谈强调了尊重患者与临终和在家中去世相关意愿的重要性。所有参与者都描述了疫情后获得及时可靠服务面临的几个挑战。及时获得居家护理、护理和卫生服务以及姑息治疗方法有助于接受PEoLC的患者在家中离世及在家中去世。
喘息护理使在家中离世及在家中去世的几率增加一倍多。及时获得包括居家护理、护理和卫生服务以及姑息治疗方法在内的服务对于支持希望在家中离世的接受PEoLC的患者至关重要。稳定居家护理团队的人员配备、规范该省社区卫生中心提供的PEoLC服务以及优化执业护士的使用将改善为接受PEoLC的患者及其护理人员提供的服务。
