肺癌、特发性肺纤维化 (IPF) 和慢性阻塞性肺疾病 (COPD) 患者的症状负担重、生活质量差、临终时医疗保健利用率高。虽然在肺癌中主动整合姑息治疗可以改善预后，但尚不清楚 COPD 和 IPF 治疗中是否采用了类似的做法。与普通患者相比，COPD 和 IPF 患者在临终时有不同的医疗保健和姑息治疗使用模式吗？肺癌？我们回顾性地确定了患有肺癌、COPD 或 IPF 的已故患者，在生命的最后六个月内，[已删除] 门诊就诊次数≥1 次。我们比较了每组生命最后 6 个月的门诊姑息治疗和阿片类药物处方、住院姑息治疗、住院治疗、重症监护使用情况以及院内死亡情况。我们使用多变量逻辑回归来计算每个结果的调整优势比，以肺癌为参考组。在 1,819 名患者中，与肺癌患者相比，患有 COPD 和 IPF 的患者在死亡时更有可能是男性和年龄较大的患者癌症。与肺癌相比，COPD 和 IPF 患者接受门诊姑息治疗的调整后赔率较低 (p<0.001)（aOR COPD：0.26，95% CI：0.19-0.36；aOR IPF：0.48，95% CI：0.32- 0.70），门诊阿片类药物（aOR COPD：0.50，95% CI：0.40-0.63；aOR IPF：0.40，95% CI：0.29-0.54），以及临终 ICU 使用的几率较高（COPD aOR：2.88） ，95% CI：2.11-3.93；IPF aOR：4.15，95% CI：2.66-6.49）。 IPF 患者接受住院姑息治疗的几率较高（aOR：2.02，95% CI：1.30-3.13，p=0.002）。患有 COPD 和 IPF 的患者接受门诊姑息治疗和阿片类药物处方的可能性较小，而更有可能使用与肺癌患者相比，临终重症监护的效果更好。进一步的研究应探索导致护理模式差异的卫生系统障碍，以优化生活质量并与患者护理目标保持一致。版权所有 © 2024。由 Elsevier Inc. 出版。

Patients with lung cancer, idiopathic pulmonary fibrosis (IPF), and chronic obstructive pulmonary disease (COPD) have high symptom burden, poor quality of life, and high healthcare utilization at the end of life. While proactive integration of palliative care in lung cancer can improve outcomes, it is unclear whether similar practices have been adopted in COPD and IPF care.Do patients with COPD and IPF have different patterns of healthcare and palliative care use at the end of life compared to lung cancer?We retrospectively identified deceased patients with lung cancer, COPD, or IPF with ≥1 outpatient visit at [removed] in the last six months of life. We compared outpatient palliative care and opioid prescriptions, inpatient palliative care, hospitalizations, intensive care use, and in-hospital death in the last 6 months of life between each group. We used multivariable logistic regression to calculate adjusted odds ratios of each outcome, with lung cancer as the reference group.Among 1,819 patients, patients with COPD and IPF were more likely to be male and older at the time of death, compared to patients with lung cancer. Compared to lung cancer, patients with COPD and IPF had a lower adjusted odds (p<0.001) of receiving outpatient palliative care (aOR COPD: 0.26, 95% CI: 0.19-0.36; aOR IPF: 0.48, 95% CI: 0.32-0.70), outpatient opioids (aOR COPD: 0.50, 95% CI: 0.40-0.63; aOR IPF: 0.40, 95% CI: 0.29-0.54), and a higher odds of end-of-life ICU use (COPD aOR: 2.88, 95% CI: 2.11-3.93; IPF aOR: 4.15, 95% CI: 2.66-6.49). Patients with IPF had higher odds of receiving inpatient palliative care (aOR: 2.02, 95% CI: 1.30-3.13, p=0.002).Patients with COPD and IPF are less likely to receive outpatient palliative care and opioid prescriptions and more likely to use end-of-life intensive care than patients with lung cancer. Further research should explore health system barriers contributing to differences in care patterns to optimize quality of life and align with patient goals of care.Copyright © 2024. Published by Elsevier Inc.