Changing Patterns in Place of Cancer Death in England: A Population-Based Study

BackgroundMost patients with cancer prefer to die at home or in a hospice, but hospitals remain the most common place of death (PoD).This study aims to explore the changing time trends of PoD and the associated factors, which are essential for end-of-life care improvement. Methods and FindingsThe study analysed all cancer deaths in England collected by the Office for National Statistics during 1993–2010 (n = 2,281,223). Time trends of age- and gender-standardised proportion of deaths in individual PoDs were evaluated using weighted piecewise linear regression. Variables associated with PoD (home or hospice versus hospital) were determined using proportion ratio (PR) derived from the log-binomial regression, adjusting for clustering effects. Hospital remained the most common PoD throughout the study period (48.0%; 95% CI 47.9%–48.0%), followed by home (24.5%; 95% CI 24.4%–24.5%), and hospice (16.4%; 95% CI 16.3%–16.4%). Home and hospice deaths increased since 2005 (0.87%; 95% CI 0.74%–0.99%/year, 0.24%; 95% CI 0.17%–0.32%/year, respectively, ppp ConclusionsMore efforts are needed to reduce hospital deaths. Health care facilities should be improved and enhanced to support the increased home and hospice deaths. People who are single, widowed, or divorced should be a focus for end-of-life care improvement, along with known at risk groups such as haematological cancer, lung cancer, older age, and deprivation. Please see later in the article for the Editors' Summary研究背景：绝大多数癌症患者更倾向于在家或临终关怀院离世，但医院仍是最常见的死亡地点（Place of Death，以下简称PoD）。本研究旨在探讨死亡地点的时间变化趋势及其相关影响因素，这对临终关怀服务的优化至关重要。 研究方法与结果：本研究分析了英国国家统计局于1993-2010年收集的英格兰地区全部癌症死亡病例（n=2,281,223）。采用加权分段线性回归，评估不同死亡地点的年龄与性别标准化死亡占比的时间趋势。通过对数二项回归得到的比例比（Proportion Ratio，PR），并校正聚类效应，确定与死亡地点（居家/临终关怀院 vs 医院）相关的变量。 在整个研究周期内，医院仍是最常见的死亡地点（占比48.0%；95%置信区间[CI] 47.9%~48.0%），其次为居家离世（24.5%；95%CI 24.4%~24.5%）和临终关怀院（16.4%；95%CI 16.3%~16.4%）。自2005年起，居家及临终关怀院离世的占比逐年上升（分别为每年0.87%；95%CI 0.74%~0.99%、每年0.24%；95%CI 0.17%~0.32%，原文此处疑似笔误，原文本为ppp）。 研究结论：需采取更多措施以降低医院内死亡的占比。应改进并完善医疗保健设施，以适配日益增长的居家及临终关怀院离世的需求。单身、丧偶或离异人群应作为临终关怀优化的重点关注对象，同时也需关注已知的高危人群，包括血液系统恶性肿瘤患者、肺癌患者、老年群体及社会经济剥夺人群。详见本文后续的编辑摘要。