We have little knowledge of differences in end-of-life care between home settings and residential aged care facilities (RACFs) where people spend most of their last year of life. This study aimed to compare end-of-life care between home settings and RACFs from the perspective of Australian general practitioners (GPs). A descriptive study was conducted with 62 GPs from Western Australia, Queensland and Victoria. Participants were asked to provide reports on end-of-life care of decedents in their practice using a validated clinic-based data collection process developed by our team between September 2018 and August 2019. Of the 213 reported expected deaths, 66.2% mainly lived at home in the last year of life. People living at home were more likely to die at a younger age (median 77 vs. 88, p < 0.001), to be male (51.1% vs. 33.3%, p = 0.01) and to die of cancer (53.9% vs. 4.2%, p < 0.001) compared to those in RACFs. There were no significant differences between the two patient groups for seven out of the eight assessed symptoms, except nausea. GPs' perceived roles in caring for patients and levels of their involvement in provision of common palliative care services were comparable between the two groups. The usual accommodation setting was most frequently considered the preferred place of death in both groups. However, more home residents ended up dying in hospital compared to RACF residents. There were significantly higher frequencies of end-of-life discussions (ORs ranged 5.46–9.82 for all topic comparisons) with GPs associated with people living at home versus RACFs. One opportunity for improved care is through promoting greater involvement of GPs in end-of-life discussions with RACF residents and staff. In general, more Australians could potentially remain at home until death if provided with greater access to essential specialist palliative care services and supportive services in home settings.

中文翻译：

---

居家养老与居家养老机构的临终关怀比较：澳大利亚全科医生的全国性研究

我们对家庭环境和住宅老年护理机构 (RACF) 之间的临终护理差异知之甚少，人们在那里度过了生命最后一年的大部分时间。本研究旨在从澳大利亚全科医生 (GP) 的角度比较家庭环境和 RACF 之间的临终关怀。对来自西澳大利亚、昆士兰和维多利亚的 62 位全科医生进行了描述性研究。参与者被要求使用我们团队在 2018 年 9 月至 2019 年 8 月期间开发的基于临床的有效数据收集流程，在他们的实践中提供关于死者临终关怀的报告。在报告的 213 例预期死亡中，66.2% 主要生活在在生命的最后一年回家。住在家里的人更有可能在更年轻的时候死去（中位数 77 对 88，p < 0.001)，成为男性（51.1% 对 33.3%，p  = 0.01）和死于癌症（53.9% 对 4.2%，p < 0.001) 与 RACF 中的那些相比。除了恶心之外，在八项评估症状中的七项中，两个患者组之间没有显着差异。全科医生在照顾患者方面的感知作用以及他们参与提供普通姑息治疗服务的程度在两组之间是可比的。通常的住宿环境最常被认为是两组的首选死亡地点。然而，与RACF居民相比，更多的家庭居民最终在医院死亡。与 RACF 相比，与居家人员相关的 GP 进行临终讨论的频率明显更高（所有主题比较的 OR 范围为 5.46-9.82）。改善护理的一个机会是通过促进全科医生更多地参与与 RACF 居民和工作人员的临终讨论。