A substantial number of patients with life-threatening illnesses like cancer receive inappropriate end-of-life care. Improving their quality of end-of-life care is a priority for patients and their families and for public health. To investigate the association between provision, timing, and initial setting of hospital-based specialist palliative care and potentially inappropriate end-of-life care for patients with cancer in two acute care hospitals in the Netherlands, we conducted a retrospective observational study using hospital administrative databases. All adults diagnosed with or treated for cancer in the year preceding their death in 2018 or 2019 were included. The main exposure was hospital-based specialist palliative care initiated >30 days before death. The outcome measures in the last 30 days of life were six quality indicators for inappropriate end-of-life care (≥2 ED-visits, ≥2 hospital admissions, >14 days hospitalization, ICU-admission, chemotherapy, hospital death). We identified 2603 deceased patients, of whom 14% (n= 359) received specialist palliative care >30 days before death (exposure group). Overall, 27% (n= 690) received potentially inappropriate end-of-life care: 19% in the exposure group, versus 28% in the non-exposure group (p< 0.001). The exposure group was 45% less likely to receive potentially inappropriate end-of-life care (AOR 0.55; 95% CI 0.41 to 0.73). Early (>90 days) and late (≤90 and >30 days) initiation of specialist palliative care, as well as outpatient and inpatient initiation, were all associated with less potentially inappropriate end-of-life care (AOR 0.49; 0.62; 0.32; 0.64, respectively). Thus, timely access to hospital-based specialist palliative care is associated with less potentially inappropriate end-of-life care for patients with cancer. The outpatient initiation of specialist palliative care seems to enhance this result.
大量患有癌症等危及生命疾病的患者接受了不恰当的临终关怀。改善临终关怀质量是患者及其家属以及公共卫生领域的优先事项。为探究荷兰两家急症医院中，基于医院的专科姑息治疗的提供、时机及初始设置与癌症患者可能不恰当临终关怀之间的关联，我们利用医院行政数据库开展了一项回顾性观察研究。研究对象包括2018年或2019年死亡前一年内被诊断或治疗癌症的所有成年患者。主要暴露因素为死亡前30天以上启动的医院专科姑息治疗。生命最后30天的结局指标为六项不恰当临终关怀质量指标（急诊就诊≥2次、住院≥2次、住院时间>14天、入住ICU、接受化疗、在医院死亡）。我们共识别出2603例死亡患者，其中14%（n=359）在死亡前30天以上接受了专科姑息治疗（暴露组）。总体而言，27%（n=690）的患者接受了可能不恰当的临终关怀：暴露组为19%，非暴露组为28%（p<0.001）。暴露组接受可能不恰当临终关怀的风险降低45%（校正比值比0.55；95%置信区间0.41-0.73）。早期（>90天）和晚期（≤90天且>30天）启动专科姑息治疗，以及门诊和住院启动方式，均与减少可能不恰当的临终关怀相关（校正比值比分别为0.49、0.62、0.32、0.64）。因此，及时获得医院专科姑息治疗与癌症患者减少可能不恰当的临终关怀相关，其中门诊启动专科姑息治疗似乎能增强这一效果。
肿瘤(癌症)患者之家