PDF(Pubmed)
Abstract：
UNASSIGNED: Relieving the total pain of patients with cancer and supporting their well-being throughout their lives are important roles of palliative and supportive care. Poverty may inhibit patients from receiving dignified end-of-life care; however, using social welfare services may reduce its impact on patients\' end-of-life experiences. Nevertheless, no study has investigated which social welfare service could lead to favorable end-of-life experiences for patients living in poverty.
UNASSIGNED: This study aimed to describe the characteristics of users of palliative care among low-income patients and examine the difference in survival time among patients with cancer on social welfare services in a single center in Kyoto, Japan.
UNASSIGNED: We conducted a retrospective cohort study.
UNASSIGNED: We included 220 patients using Public Assistance (PA: aid minimum income and medical/long-term care), Free/Low-Cost Medical Care (FLCMC: aid only medical care), and nonwelfare-users who newly received palliative care in 2021.
UNASSIGNED: We calculated patients\' survival time from the initiation of palliative care to death. In addition, we identified patients who experienced home death.
UNASSIGNED: Compared with nonusers, FLCMC beneficiaries had shorter survival times (adjusted hazard ratio [aHR] 2.05, 95% confidence interval [CI] 0.80-5.22). No difference was observed among PA beneficiaries (aHR 1.19, 95% CI 0.49-2.87). No home death was observed among welfare service recipients.
UNASSIGNED: Social welfare benefits only for medical expenses may not sufficiently support dignified end-of-life care for low-income patients. Further studies are required to examine the robustness of this study considering various bio-psycho-social factors that can influence these findings, to support low-income patients with cancer on social welfare services.
UNASSIGNED: This study aimed to describe the characteristics of users of palliative care among low-income patients and examine the difference in survival time among patients with cancer on social welfare services in a single center in Kyoto, Japan.
UNASSIGNED: We conducted a retrospective cohort study.
UNASSIGNED: We included 220 patients using Public Assistance (PA: aid minimum income and medical/long-term care), Free/Low-Cost Medical Care (FLCMC: aid only medical care), and nonwelfare-users who newly received palliative care in 2021.
UNASSIGNED: We calculated patients\' survival time from the initiation of palliative care to death. In addition, we identified patients who experienced home death.
UNASSIGNED: Compared with nonusers, FLCMC beneficiaries had shorter survival times (adjusted hazard ratio [aHR] 2.05, 95% confidence interval [CI] 0.80-5.22). No difference was observed among PA beneficiaries (aHR 1.19, 95% CI 0.49-2.87). No home death was observed among welfare service recipients.
UNASSIGNED: Social welfare benefits only for medical expenses may not sufficiently support dignified end-of-life care for low-income patients. Further studies are required to examine the robustness of this study considering various bio-psycho-social factors that can influence these findings, to support low-income patients with cancer on social welfare services.
摘要：
■减轻癌症患者的总疼痛并支持他们一生的健康是姑息治疗和支持治疗的重要作用。贫困可能会阻碍患者获得有尊严的临终关怀；然而，使用社会福利服务可能会减少其对患者临终体验的影响。然而，没有研究调查哪种社会福利服务可以为生活贫困的患者带来有利的临终体验。
■本研究旨在描述低收入患者中姑息治疗使用者的特征，并研究癌症患者在京都单一中心社会福利服务中的生存时间差异，日本。
■我们进行了一项回顾性队列研究。
■我们纳入了220名使用公共援助（PA：援助最低收入和医疗/长期护理）的患者，免费/低成本医疗（FLCMC：仅援助医疗），以及2021年新接受姑息治疗的非福利使用者。
■我们计算了患者从姑息治疗开始到死亡的生存时间。此外,我们确定了经历过家庭死亡的患者。
■与非用户相比，FLCMC受益人的生存时间较短（调整后的风险比[aHR]2.05，95％置信区间[CI]0.80-5.22）。PA受益人之间没有观察到差异（aHR1.19，95%CI0.49-2.87）。在福利服务接受者中没有观察到家庭死亡。
■仅用于医疗费用的社会福利可能不足以支持低收入患者有尊严的临终关怀。需要进一步的研究来检查这项研究的稳健性，考虑到各种可能影响这些发现的生物心理社会因素，为低收入癌症患者提供社会福利服务。
■本研究旨在描述低收入患者中姑息治疗使用者的特征，并研究癌症患者在京都单一中心社会福利服务中的生存时间差异，日本。
■我们进行了一项回顾性队列研究。
■我们纳入了220名使用公共援助（PA：援助最低收入和医疗/长期护理）的患者，免费/低成本医疗（FLCMC：仅援助医疗），以及2021年新接受姑息治疗的非福利使用者。
■我们计算了患者从姑息治疗开始到死亡的生存时间。此外,我们确定了经历过家庭死亡的患者。
■与非用户相比，FLCMC受益人的生存时间较短（调整后的风险比[aHR]2.05，95％置信区间[CI]0.80-5.22）。PA受益人之间没有观察到差异（aHR1.19，95%CI0.49-2.87）。在福利服务接受者中没有观察到家庭死亡。
■仅用于医疗费用的社会福利可能不足以支持低收入患者有尊严的临终关怀。需要进一步的研究来检查这项研究的稳健性，考虑到各种可能影响这些发现的生物心理社会因素，为低收入癌症患者提供社会福利服务。
