Hunt R, Bonett A, Roder D
Southern Community Hospice Programme, Repatriation General Hospital, Adelaide, SA.
Aust N Z J Med. 1993 Jun;23(3):245-51. doi: 10.1111/j.1445-5994.1993.tb01725.x.
The increasing numbers of cancer patients, the high costs of terminal care, and the development of palliative care services have led to a growing interest in patterns of terminal cancer care. These patterns are relevant to the formulation and evaluation of health services policy.
To investigate trends in the place of death of South Australian cancer patients between 1981 and 1990, and to examine associations of socio-demographic and clinical variables with the place of death.
Data relating to 2715 deaths attributed to cancer in 1990 were extracted from the Central Cancer Registry. To assess trends, these data were directly standardised to the age-sex distribution of cancer deaths in 1981 and 1985 which were investigated in a previous study. Unconditional logistic regression was used to investigate predictors of place of death.
The proportion of deaths which occurred in major metropolitan public hospitals decreased from 40% in 1981 to 28% in 1990. Conversely, the proportion which occurred in hospice units increased from 5% to 20% over the same period. There was a decline in the proportion of deaths which occurred in private hospitals, but there was no significant change in the proportion which occurred in country hospitals or nursing homes. The proportion of deaths at home remained around 14%. Associated with place of death were age, sex, type of malignancy, survival time from diagnosis to death, Aboriginality, and area of residence. Further research to assess the clinical appropriateness of terminal care patterns is suggested.
癌症患者数量不断增加、临终护理成本高昂以及姑息治疗服务的发展，使得人们对晚期癌症护理模式的兴趣日益浓厚。这些模式与卫生服务政策的制定和评估相关。
调查1981年至1990年间南澳大利亚癌症患者的死亡地点趋势，并研究社会人口统计学和临床变量与死亡地点之间的关联。
从中央癌症登记处提取了1990年归因于癌症的2715例死亡的数据。为评估趋势，这些数据被直接标准化为先前研究中调查的1981年和1985年癌症死亡的年龄-性别分布。使用无条件逻辑回归来研究死亡地点的预测因素。
在主要大都市公立医院发生的死亡比例从1981年的40%下降到1990年的28%。相反，同期在临终关怀病房发生的死亡比例从5%增加到20%。在私立医院发生的死亡比例有所下降，但在乡村医院或疗养院发生的死亡比例没有显著变化。在家中死亡的比例保持在14%左右。与死亡地点相关的因素有年龄、性别、恶性肿瘤类型、从诊断到死亡的存活时间、原住民身份和居住地区。建议进行进一步研究以评估临终护理模式的临床适宜性。
