Defining cancer patients as being in the terminal phase: Who receives a formal diagnosis, and what are the effects?

被引:56
作者
Aabom, B
Kragstrup, J
Vondeling, H
Bakketeig, LS
Stovring, H
机构
[1] Univ So Denmark, Res Unit Gen Practice, DK-5000 Odense, Denmark
[2] Univ So Denmark, Unit Hlth Econ, DK-5000 Odense, Denmark
[3] Univ So Denmark, Epidemiol Unit, Inst Publ Hlth, DK-5000 Odense, Denmark
关键词
D O I
10.1200/JCO.2005.16.493
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Physicians either do not define cancer patients as being terminal, or their prognostic estimates tend to be optimistic. This might affect patients' appropriate and timely referral to specialist palliative care services or can lead to unintended acute hospitalization. Patients and Methods We used the Danish Cancer Register and four administrative registers to perform a retrospective cohort study in 3,445 patients who died as a result of cancer. We used the Danish "terminal declaration" issued by a physician as a proxy for a formal terminal diagnosis (prognosis of death within 6 months). The terminal declaration gives right to economic benefits and increased care for the dying. We investigated patient-related factors of receiving an explicit terminal diagnosis by logistic regression and then analyzed the effects of such a diagnosis on admission rate per week and place of death. Results Thirty-four percent of patients received a formal terminal diagnosis. Age of >= 70 years (odds ratio [OR], 0.44; 95% CI, 0.34 to 0.56; P < .001), women (OR, 0.81; 95% CI, 0.69 to 0.96; P = .02), hematologic cancer (OR, 0.20; 95% CI, 0.09 to 0.41; P < .001), and a less than 1-month survival time (OR, 0.10; 95% CI, 0.07 to 0.15; P < .001) were associated with a lesser likelihood of receiving a formal terminal diagnosis. Explicit terminal diagnosis was associated with lower admission rate and an adjusted OR of hospital death of 0.25 (95% CI, 0.21 to 0.29). Conclusion Women and the elderly were less likely to receive a formal terminal diagnosis. The formal terminal diagnosis reduced hospital admissions and increased the possibilities of dying at home.
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页码:7411 / 7416
页数:6
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