Ecology of End-of-life Medical Care for Advanced Cancer Patients in China.

Fei Yang, Anli Leng, Jun Jing, Mary Miller, Bee Wee
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Abstract

Aims: Cancer is a leading cause of death worldwide. Approximately 30% of global cancer-related deaths occur in mainland China. However, there is a paucity of information regarding the end-of-life care-seeking behavior of patients with advanced cancer in China. Our study was to investigate end-of-life care-seeking behavior and to quantify the association between sociodemographic characteristics and the location and pattern of end-of-life care.

Methods: We conducted a mortality follow-back survey using caregivers' interviews to estimate the number of individuals pre 1000 who died between 2013 and 2021 in the last 3 months of life. We collected data on hospitalization, outpatient visits, cardiopulmonary resuscitation, palliative care and hospice utilization, and place of death, stratified by age, gender, marital status, household income, residential zone, insurance type, and the primary end-of-life decision-maker of the decedents.

Results: We analyzed data from 857 deceased cancer patients, representing an average of 1000 individuals. Among these patients, 861 experienced at least moderate or more severe pain, 774 were hospitalized at least once, 468 received intensive treatment, 389 had at least one outpatient visit, 270 died in the hospital, 236 received cardiopulmonary resuscitation and 99 received specialist hospice care.

Conclusions: Our study provides insights into the end-of-life care-seeking behavior of advanced cancer patients in China and our findings serve as a useful benchmark for estimating the use of end-of-life medical care. It highlights the need for the establishment of an accessible and patient-centered palliative care and hospice system.

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中国晚期癌症患者临终医疗生态
目的:癌症是世界范围内死亡的主要原因。全球约30%的癌症相关死亡发生在中国大陆。然而,关于中国晚期癌症患者的临终关怀行为的信息缺乏。我们的研究旨在调查临终关怀寻求行为,并量化社会人口学特征与临终关怀的地点和模式之间的关系。方法:我们使用护理人员访谈进行了死亡率随访调查,以估计2013年至2021年间在生命的最后3个月内死亡的1000岁以下个体的数量。我们收集了住院、门诊就诊、心肺复苏、姑息治疗和临终关怀利用以及死亡地点的数据,并根据死者的年龄、性别、婚姻状况、家庭收入、居住地、保险类型和主要临终决策者进行了分层。结果:我们分析了857名已故癌症患者的数据,平均代表1000人。在这些患者中,861人经历了至少中度或更严重的疼痛,774人至少住院一次,468人接受了强化治疗,389人至少有一次门诊就诊,270人在医院死亡,236人接受了心肺复苏,99人接受了专科临终关怀。结论:我们的研究揭示了中国晚期癌症患者的临终关怀行为,我们的研究结果为评估临终医疗服务的使用提供了有用的基准。它强调需要建立一个方便和以病人为中心的姑息治疗和临终关怀系统。
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