Gray J D, Forster D P
Department of Epidemiology and Public Health, Medical School, University of Newcastle, Newcastle on Tyne.
J Public Health Med. 1997 Dec;19(4):464-9. doi: 10.1093/oxfordjournals.pubmed.a024678.
Palliative care services have been criticized for providing specialist care for a privileged few but there is no routinely available information to prove or refute these criticisms. Our survey aimed to identify and describe the patients using specialist palliative care services in a Health District and identify whether any factors distinguished them from other eligible patients who did not use these services.
Clinical and demographic data were collected retrospectively for all residents of the Health District who died of cancer during 1991. Comparisons were made between those who used specialist palliative care services and those who did not.
A total of 521 cases were studied of which 157 (30 per cent) had used the specialist palliative care services. These cases (Group 1) compared with the remainder (Group 2) were statistically significantly (p < 0.05) different in terms of their age at death (mean age for Group 1 was 66.6 years, compared with 73 years for Group 2), survival times from diagnosis (median number of days for Group 1 was 242, compared with 110 days for Group 2) and general practitioner practice. There were no significant differences between the two groups for all other variables, i.e. ward of residence, social class, cancer site and gender. Cases in Group 1 were more likely to die at home (39 per cent compared with 27 per cent in Group 2).
Effectiveness studies in the field of palliative care are essential but difficult. We suggest that there is an important place for local studies of needs and utilization for guiding sensitive contracting.
姑息治疗服务因只为少数特权阶层提供专科护理而受到批评，但目前尚无常规可得的信息来证实或反驳这些批评。我们的调查旨在识别和描述在一个健康区使用专科姑息治疗服务的患者，并确定是否有任何因素使他们与其他未使用这些服务的符合条件的患者有所不同。
对1991年期间在该健康区死于癌症的所有居民的临床和人口统计学数据进行回顾性收集。对使用专科姑息治疗服务的患者和未使用的患者进行了比较。
共研究了521例病例，其中157例（30%）使用了专科姑息治疗服务。这些病例（第1组）与其余病例（第2组）相比，在死亡年龄（第1组的平均年龄为66.6岁，第2组为73岁）、诊断后的生存时间（第1组的中位数天数为242天，第2组为110天）和全科医生执业情况方面存在统计学显著差异（p<0.05）。在所有其他变量方面，两组之间没有显著差异，即居住病房、社会阶层、癌症部位和性别。第1组的病例更有可能在家中死亡（39%，而第2组为27%）。
姑息治疗领域的有效性研究至关重要但困难重重。我们认为，开展关于需求和利用情况的本地研究对于指导敏感的合同签订具有重要意义。
