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Hagen TP, Zelko E. Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors. Healthcare (Basel) 2024; 12:943. [PMID: 38727500 PMCID: PMC11083566 DOI: 10.3390/healthcare12090943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/18/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. DATA AND METHODS Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. RESULTS Patients with dementia were more commonly placed in nursing homes than patients in the two other groups, while patients with heart failure and breast cancer were more frequently hospitalized than the dementia patients. Breast cancer and heart failure patients had a higher likelihood of dying at home than dementia patients. The higher the number of general practitioners, the higher was the probability of home-based end-of-life care for cancer patients, while an increasing non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. CONCLUSIONS Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care. The higher the availability of health care services, the higher also is the probability of ending the life at home.
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Affiliation(s)
- Terje P. Hagen
- Department of Health Management and Health Economics, University of Oslo, Blindern, P.O. Box 1072, 0316 Oslo, Norway
| | - Erika Zelko
- Institute of General Medicine, Johannes Kepler University, Altenberger Straße 69, 4040 Linz, Austria;
- Institute of Palliative Medicine, Medical Faculty, University Maribor, Slomskov trg 15, 2000 Maribor, Slovenia
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2
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Konlan KD, Im S, Afaya A. End of life decisions and preference of place of death among geriatric and chronic disease patients: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100108. [PMID: 38745625 PMCID: PMC11080430 DOI: 10.1016/j.ijnsa.2022.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background Geriatric and chronic disease patients and families consider the nature, time, and place of death because issues related to the end of life are rarely discussed. This study assessed the end of life decisions and preferences among geriatric and chronic disease patients. Methods There was an in-depth search in five electronic databases (PubMed Central, CINAHL, Embase, Web of Science, and Scopus) using the population, concept, and context, framework. A matrix was developed, discussed, accepted, and used for data extraction. Convergent synthesis and thematic data analysis technique were adopted for the analysis. The reporting of findings was done in accordance with the JBI and PRISMA guidelines for reviews. Results From the data analysis, home-based end of life care was intuitive and included home visits, telephone follow-up, and patient-initiated services. The key themes that emerged from our analysis that sought to influence end end of life decisions were 1) approach to home-based end of life care, 2) patient and family characteristics, 3) clinical characteristics of the patient, 4) health care provider factors, 5) satisfaction and care rendered to the patient and family, 6) family preference of the place of death, 7) collaboration between multidisciplinary teams of care, and 8) challenges associated with the home-based end of life care. The personal characteristics of the nurse (age, personal and work experience, nursing perspective, and competence) and conducting a home visit influenced patient and family end of life decision. Multidisciplinary care teams (nurses and palliative care specialists) were important in delivering effective end-of-life services. Conclusion To support patients in making informed decisions, they must be educated on expected outcomes and implications, adverse impacts of decisions, and the emotional influence on the bereaved family. It is important that divergent technological methods are leveraged to provide essential care to patients nearing the end of life at home. Advancing the quality of end of life care techniques through home visiting will improve the feeling of patients and families about the dying process. Tweetable abstracts End-of-life preferences warrants that, divergent technological methods are leveraged to provide care to patients nearing the end of life.
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Affiliation(s)
- Kennedy Diema Konlan
- Mo- Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Seah Im
- Sahmyook University, College of Nursing., 815, Hwarang-ro, Nowon-gu, Seoul, 01795, Korea
| | - Agani Afaya
- Yonsei University College of Nursing., 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
- Department Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Watanabe T, Matsushima M, Kaneko M, Aoki T, Sugiyama Y, Fujinuma Y. Death at home versus other locations in older people receiving physician‐led home visits: A multicenter prospective study in Japan. Geriatr Gerontol Int 2022; 22:1005-1012. [PMID: 36374192 PMCID: PMC10100087 DOI: 10.1111/ggi.14496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/22/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Japanese government is promoting physician-led home visits as well as end-of-life care at home. However, the proportion of deaths occurring at home has remained unchanged for the past 20 years. OBJECTIVES To report the cumulative incidence of deaths at home and to explore the factors associated with deaths at home versus other places, mainly hospitals. METHODS This was a multicenter prospective cohort study in a primary care setting. We enrolled patients aged ≥65 years who had started to receive regular visits by family physicians from 13 facilities in and around Tokyo between February 1, 2013 and January 31, 2016. Patients were followed-up until January 31, 2017. The primary outcome measures were mortality rate and cumulative incidence of deaths at home. RESULTS We enrolled 762 patients. Of 368 deaths, 133 occurred in the patient's home. The mortality rates at home were 137.6/1000 person-years (95% confidence interval 116.1-163.1). In cumulative incidence function, the longer duration of care at home lowers the likelihood of death at home. Multivariable multinomial logistic models showed that younger age and higher Barthel Index score reduced the likelihood of deaths at home, while receiving oxygen therapy and the presence of a full-time caregiver increased the likelihood of deaths at home relative to deaths at other locations. CONCLUSIONS Of deceased patients, only one-third died in patients' homes. We found several factors associated with deaths at home, which appeared to reflect the readiness of patients and their families for death. Geriatr Gerontol Int 2022; 22: 1005-1012.
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Affiliation(s)
- Takamasa Watanabe
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
- Centre for Family Medicine Development Japanese Health and Welfare Co‐operative Federation Tokyo Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
- Department of Health Data Science Yokohama City University Yokohama Japan
- Division of Community Health and Primary Care Center for Medical Education, The Jikei University School of Medicine Tokyo Japan
| | - Makoto Kaneko
- Department of Health Data Science Yokohama City University Yokohama Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
| | - Yoshifumi Sugiyama
- Division of Clinical Epidemiology Research Center for Medical Sciences, The Jikei University School of Medicine Tokyo Japan
- Division of Community Health and Primary Care Center for Medical Education, The Jikei University School of Medicine Tokyo Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development Japanese Health and Welfare Co‐operative Federation Tokyo Japan
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Fereidouni A, Rassouli M, Salesi M, Ashrafizadeh H, Vahedian-Azimi A, Barasteh S. Preferred Place of Death in Adult Cancer Patients: A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:704590. [PMID: 34512460 PMCID: PMC8429937 DOI: 10.3389/fpsyg.2021.704590] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Identifying the preferred place of death is a key indicator of the quality of death in cancer patients and one of the most important issues for health service policymakers. This study was done to determine the preferred place of death and the factors affecting it for adult patients with cancer. Methods: In this systematic review and meta-analysis study four online databases (PubMed, Scopus, web of science, ProQuest) were searched by relevant keywords. Quality assessment of papers was conducted using Newcastle-Ottawa (NOS) criterion. Odds ratios, relative risks, and 95% confidence intervals were determined for each of the factors extracted from the investigations. Results: A total of 14,920 participants of 27 studies were included into the meta-analysis. Based on the results, 55% of cancer patients with a confidence interval [95% CI (41–49)] preferred home, 17% of patients with a confidence interval [95% CI (−12%) 23)] preferred hospital and 10% of patients with confidence interval [95% CI (13–18)] preferred hospices as their favored place to die. Effective factors were also reported in the form of demographic characteristics, disease-related factors and psychosocial factors. Conclusions: This study showed that more than half of cancer patients chose home as their preferred place of death. Therefore, guided policies need to ensure that the death of the patients in the preferred place should be considered with priority. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020218680, identifier: CRD42020218680.
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Affiliation(s)
- Armin Fereidouni
- Medicine, Quran and Hadith Research Center, Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hadis Ashrafizadeh
- Student Research Committee, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Boo S, Lee J, Oh H. Cost of Care and Pattern of Medical Care Use in the Last Year of Life among Long-Term Care Insurance Beneficiaries in South Korea: Using National Claims Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239078. [PMID: 33291790 PMCID: PMC7730132 DOI: 10.3390/ijerph17239078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022]
Abstract
In Korea, a substantial proportion of long-term care insurance (LTCI) beneficiaries die within 1 year of seeking the benefit. This study was conducted to evaluate the pattern of medical care use and care cost during the last year of life among Korean LTCI beneficiaries between 2009 and 2013 using the national claims data. The National Health Insurance’s Senior (NHIS-Senior) cohort was used for this retrospective study. The participants were LTCI beneficiaries aged 65 or over as of 2008 who died between 2009 and 2013 (N = 30,433). Medical costs during the last year of life were highest for those who used both medical care services and long-term care (LTC) services and increased as death approached. About half of the participants were hospitalized at the time of death. The use of LTC services at the time of death increased from 13.0 to 22.8%, while those who died at home decreased from 34 to 20%. This study suggests that the use of LTC services did not reduce medical costs by substituting unnecessary inpatient hospitalization. Quality of dying should be considered one of the goals of older adult care, and provisions should be made for palliative care at home or LTC facilities.
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Affiliation(s)
- Sunjoo Boo
- Research Institute of Nursing Science, College of Nursing, Ajou University, Suwon 16499, Korea
- Correspondence: (S.B.); (H.O.)
| | - Jungah Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 71, Daehak-ro, Jongno-gu, Seoul 03082, Korea;
| | - Hyunjin Oh
- College of Nursing, Gachon University, Incheon 98105, Korea
- Correspondence: (S.B.); (H.O.)
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Sato M, Tamiya N, Jin X, Watanabe T, Takahashi H, Noguchi H. Impact of a Japanese Incentivization Program to Increase End-of-Life Care Outside of Hospitals. J Am Med Dir Assoc 2020; 22:329-333. [PMID: 33160874 DOI: 10.1016/j.jamda.2020.09.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyze the association of an incentivization program to promote death outside of hospitals with changes in place of death. DESIGN A longitudinal observational study using national databases. SETTING AND PARTICIPANTS Participants comprised Japanese decedents (≥65 years) who had used long-term care insurance services and died between April 2007 and March 2014. METHODS Using a database of Japanese long-term care insurance service claims, subjects were divided into community-dwelling and residential aged care (RAC) facility groups. Based on national death records, change in place of death after the Japanese government initiated incentivization program was observed using logistic regression. RESULTS Hospital deaths decreased by 8.7% over time, mainly due to an increase in RAC facility deaths. The incentivization program was more associated with decreased in-hospital deaths for older adults in RAC facilities than community-dwelling older adults. CONCLUSIONS AND IMPLICATIONS In Japan, the proportion of in-hospital deaths of frail older adults decreased since the health services system introduced the incentivization program for end-of-life care outside of hospitals. The shift of place of death from hospitals to different locations was more prominent among residents of RAC facilities, where informal care from laymen was required less, than among community residents.
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Affiliation(s)
- Mikiya Sato
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan; Health Services Center, Human Resources Group, Sumitomo Heavy Industries, ltd., Tokyo, Japan.
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Xueying Jin
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Taeko Watanabe
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | | | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, Tokyo, Japan
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Lee JE, Lee J, Lee H, Park JK, Park Y, Choi WS. End-of-life care needs for noncancer patients who want to die at home in South Korea. Int J Nurs Pract 2020; 26:e12808. [PMID: 31975562 DOI: 10.1111/ijn.12808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/10/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
AIM The awareness for the need for end-of-life care has increased among noncancer patients. However, studies on the topic have rarely targeted the needs of noncancer patients who want to die at home. This study assessed the end-of-life care needs of noncancer patients who were receiving care and wanted to die at home. METHODS A cross-sectional study design was used and involved 200 participants who were diagnosed as noncancer patients and receiving home care nursing. Data were collected on demographics, disease, Palliative Performance Scale (PPS) scores, and end-of-life care needs, in April and May, 2016. RESULTS Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives." Multivariate analysis revealed that the duration of home care nursing held a significant association with end-of-life care needs. CONCLUSION By reflecting on the comprehensive care needs of patients with chronic illnesses and including them in the care process, it will be possible to provide better quality palliative care to patients at home in the end-of-life stages.
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Affiliation(s)
- Jong-Eun Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Jiwon Lee
- College of Nursing, Ajou University, Suwon, Republic of Korea
| | - Hanul Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | | | - Younghye Park
- Team Manager in Home Care, Seoul St. Mary's Hospital, Seoul, Korea
| | - Whan Seok Choi
- Department of Family Care Medicine, Seoul St. Mary's Hospital, Seoul, Korea
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Hospital and Patient Characteristics Regarding the Place of Death of Hospitalized Impending Death Patients: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234609. [PMID: 31757082 PMCID: PMC6926854 DOI: 10.3390/ijerph16234609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 11/30/2022]
Abstract
Objectives: To explore the influence of hospital and patient characteristics on deaths at home among inpatients facing impending death. Method: In this historical cohort study, 95,626 inpatients facing impending death from 362 hospitals in 2011 were recruited. The dependent variable was the place of death. The independent variables were the characteristics of the hospitals and the patients. A two-level hierarchical generalized linear model was used. Results: In total, 41.06% of subjects died at home. The hospital characteristics contributed to 29.25% of the total variation of the place of death. Private hospitals (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.00–1.75), patients >65 years old (OR = 1.48, 95% CI. = 1.42–1.54), married (OR = 3.15, 95% CI. = 2.93–3.40) or widowed (OR = 3.39, 95% CI. = 3.12–3.67), from near-poor households (OR = 5.16, 95% CI. = 4.57–5.84), having diabetes mellitus (OR = 1.79, 95% CI. = 1.65–1.94), and living in a subcounty (OR = 2.27, 95% CI. = 2.16–2.38) were all risk factors for a death at home. Conclusion: Both hospital and patient characteristics have an effect of deaths at home among inpatients facing impending death. The value of the inpatient mortality rate as a major index of hospital accreditation should be interpreted intrinsically with the rate of deaths at home.
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Masumoto S, Sato M, Ichinohe Y, Maeno T. Factors facilitating home death in non-cancer older patients receiving home medical care. Geriatr Gerontol Int 2019; 19:1231-1235. [PMID: 31691507 DOI: 10.1111/ggi.13800] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 09/08/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
AIM To assess factors associated with home deaths in non-cancer elderly patients receiving home medical care by general practitioners. METHODS A retrospective observational study was carried out in a primary care clinic in Tokyo. Patients who received home medical care and died between January 2010 and September 2017 were included in the analysis. Data from 119 non-cancer patients aged ≥65 years were collected between September and December 2017 using medical records. Patient characteristics, comorbidities, cognitive impairment, duration of home medical care, number of household members, patient's relationship with their primary caregiver, use of home care nursing services, and patient and family preference on place of death were obtained as independent variables. The main outcome was the place of death. RESULTS Among the analyzed patients, 59.7% had impaired cognition and 47.1% expressed a preference for place of death. Patient-family congruence on the preferred place of death was 57.1% (kappa coefficient 0.39). Multivariate analysis showed that family preference for home death (adjusted odds ratio [aOR] 137.0, 95% CI 13.0-1443.8), cognitive impairment (aOR 4.26, 95% CI 1.12-16.2), death by non-infectious diseases (aOR 13.7, 95% CI 2.50-74.7) and living with more than two family members (aOR 4.79, 95%CI 1.38-16.7) were significantly associated with home deaths. CONCLUSIONS Family preference, rather than patient preference, was a facilitating factor for home death among non-cancer older patients receiving home medical care. As many patients receiving home medical care have impaired cognition, early end-of-life discussions with patients and decision-making support for caregivers should be promoted to realize their preferences on place of death. Geriatr Gerontol Int 2019; 19: 1231-1235.
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Affiliation(s)
- Shoichi Masumoto
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Kawakita Center for Family Medicine, Kawakita General Hospital, Tokyo, Japan
| | - Mikiya Sato
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yumiko Ichinohe
- Kawakita Center for Family Medicine, Kawakita General Hospital, Tokyo, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Ishikawa T, Fukui S, Okamoto Y. Advance care planning and home death in patients with advanced cancer: a structured interview analysis. Int J Palliat Nurs 2019; 24:418-426. [PMID: 30260301 DOI: 10.12968/ijpn.2018.24.9.418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: Discrepancy between preferred and actual place of death is common in patients with advanced cancer. AIM: To investigate the association between advance care planning (ACP) and home death in patients with advanced cancer. METHODS: Using structured interviews, 44 primary nurses from 19 home-visit nursing agencies in Japan were asked about status changes for 123 advanced cancer patients receiving home care. The main outcome was the place of death. RESULTS: Of the 123 patients, 16 were alive, 54 died at home and 53 died at hospital. Multivariate analyses revealed that home death was more likely if: i) physicians or nurses practised ACP during the whole home-visit period (odds ratio (OR) 41.76; confidence interval (CI) 5.87-297.07); ii) patients had adequate insight concerning their prognosis just before death or at hospitalisation (OR 7.85; CI 1.18-52.24); and iii) the baseline preference of families was a home death (OR 0.09; 95% CI 0.01-0.73). CONCLUSION: ACP practiced by physicians or nurses for advanced cancer patients may contribute to achieving home death.
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Affiliation(s)
- Takako Ishikawa
- Assistant Professor, Faculty of Nursing, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Sakiko Fukui
- Professor, Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuko Okamoto
- Assistant Professor, Tokyo Metropolitan University, Faculty of Health Sciences, Tokyo, Japan
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Hirano H, Shimizu C, Kawachi A, Ozawa M, Higuchi A, Yoshida S, Shimizu K, Tatara R, Horibe K. Preferences Regarding End-of-Life Care Among Adolescents and Young Adults With Cancer: Results From a Comprehensive Multicenter Survey in Japan. J Pain Symptom Manage 2019; 58:235-243.e1. [PMID: 31077783 DOI: 10.1016/j.jpainsymman.2019.04.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 12/31/2022]
Abstract
CONTEXT Patient preferences influence end-of-life (EOL) care which patients receive. However, preferences regarding EOL care among adolescent and young adult (AYA) cancer population remain unclear. OBJECTIVES The objective of the study was to evaluate preferences regarding EOL care among AYA cancer population. METHODS We evaluated preferences regarding EOL care as a part of a comprehensive multicenter questionnaire study investigating the experience and needs of Japanese AYA cancer population. RESULTS A total of 349 AYA cancer population (213 AYA cancer patients and 136 AYA cancer survivors) were evaluated. Eighty-six percent (296/344), 53% (180/338), 88% (301/341), and 61% (207/342) of participants with valid response preferred to have prognostic disclosure, receive palliative chemotherapy for incurable cancer with limited efficacy at the expense of considerable toxicity, actively use palliative care, and stay home at EOL, respectively. In multivariate analysis, the preference regarding prognostic disclosure was associated positively with no child status (odds ratio [OR] = 3.05, P = 0.003) and negatively with history of chemotherapy (OR = 0.23, P = 0.009), the preference regarding palliative chemotherapy for incurable cancer with limited efficacy at the expense of considerable toxicity was associated positively with status under active cancer treatment (OR = 1.74, P = 0.03), and the preference of staying home at EOL was positively associated with anxiety (OR = 1.72, P = 0.04). CONCLUSION This study elucidated preferences regarding EOL care among Japanese AYA cancer population. These findings may help health care practitioners to have better understanding of preferences regarding EOL care among this population.
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Affiliation(s)
- Hidekazu Hirano
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan; Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan; Department of Medicine, Keio University Graduate School of Medicine, Tokyo, Japan
| | - Chikako Shimizu
- Department of Breast Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Asuka Kawachi
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Miwa Ozawa
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Akiko Higuchi
- Children's Cancer Association of Japan, Tokyo, Japan
| | - Saran Yoshida
- Graduate School of Education, Tohoku University, Sendai, Miyagi, Japan
| | - Ken Shimizu
- Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ryohei Tatara
- Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan; Clinical Department of Palliative Medicine, Osaka City General Hospital, Osaka, Japan
| | - Keizo Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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12
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Lee H, Lee J, Lee JE. Bereaved Families' Experiences of End-of-Life Care at Home for Older Adults with Non-Cancer in South Korea. J Community Health Nurs 2019; 36:42-53. [PMID: 30606059 DOI: 10.1080/07370016.2018.1554768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to gain an understanding of the experiences of families who care for older adults with non-cancer diseases at the end of their lives. The data accrued through in-depth interviews, analyzed using Giorgi's phenomenological method: caregiving burden; situational responsibility; consolation by support; and mourning for the deceased. In Korean culture, adult children had the responsibility of caring for their aged parents as a burden of caregiving and as a main motive for caregiving. Educational and psychological support programs for caregivers should aim to boost confidence, rather than merely focusing on their burden.
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Affiliation(s)
- Hanul Lee
- a College of Nursing , The Catholic University of Korea , Seoul , Republic of Korea
| | - Jiwon Lee
- a College of Nursing , The Catholic University of Korea , Seoul , Republic of Korea
| | - Jong-Eun Lee
- a College of Nursing , The Catholic University of Korea , Seoul , Republic of Korea
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Tan WS, Bajpai R, Low CK, Ho AHY, Wu HY, Car J. Individual, clinical and system factors associated with the place of death: A linked national database study. PLoS One 2019; 14:e0215566. [PMID: 30998764 PMCID: PMC6472886 DOI: 10.1371/journal.pone.0215566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 04/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many middle- and high-income countries face the challenge of meeting preferences for home deaths. A better understanding of associated factors could support the design and implementation of policies and practices to enable dying at home. This study aims to identify factors associated with the place of death in Singapore, a country with a strong sense of filial piety. SETTINGS/PARTICIPANTS A retrospective cohort of 62,951 individuals (≥21 years old) who had died from chronic diseases in Singapore between 2012-2015 was obtained. Home death was defined as a death that occurred in a private residence whereas non-home deaths occurred in hospitals, nursing homes, hospices and other locations. Data were obtained by extracting and linking data from five different databases. Hierarchical multivariable logistic regression models were used to examine the effects of individual, clinical and system factors sequentially. RESULTS Twenty-eight percent of deaths occurred at home. Factors associated with home death included being 85 years old or older (OR 4.45, 95% CI 3.55-5.59), being female (OR 1.21, 95% CI 1.16-1.25), and belonging to Malay ethnicity (OR 1.91, 95% CI 1.82-2.01). Compared to malignant neoplasm, deaths as a result of diabetes mellitus (OR 1.93, 95% CI 1.69-2.20), and cerebrovascular diseases (OR 1.28, 95% CI 1.19-1.36) were also associated with a higher likelihood of home death. Independently, receiving home palliative care (OR 3.45, 95% CI 3.26-3.66) and having a documented home death preference (OR 5.08, 95% CI 3.96-6.51) raised the odds of home deaths but being admitted to acute hospitals near the end-of-life was associated with lower odds (OR 0.92, 95% CI 0.90-0.94). CONCLUSION Aside from cultural and clinical factors, system-based factors including access to home palliative care and discussion and documentation of preferences were found to influence the likelihood of home deaths. Increasing home palliative care capacity and promoting advance care planning could facilitate home deaths if this is the desired option of patients.
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Affiliation(s)
- Woan Shin Tan
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore
- * E-mail:
| | - Ram Bajpai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chan Kee Low
- Economics Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Andy Hau Yan Ho
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Huei Yaw Wu
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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14
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LEE J, PARK Y, LIM K, LEE A, LEE H, LEE JE. Care Needs of Patients at the End of Life With a Noncancer Diagnosis Who Live at Home. J Nurs Res 2019; 27:e10. [DOI: 10.1097/jnr.0000000000000277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Ko MC, Huang SJ, Chen CC, Chang YP, Lien HY, Lin JY, Woung LC, Chan SY. Factors predicting a home death among home palliative care recipients. Medicine (Baltimore) 2017; 96:e8210. [PMID: 29019887 PMCID: PMC5662310 DOI: 10.1097/md.0000000000008210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Awareness of factors affecting the place of death could improve communication between healthcare providers and patients and their families regarding patient preferences and the feasibility of dying in the preferred place.This study aimed to evaluate factors predicting home death among home palliative care recipients.This is a population-based study using a national representative sample retrieved from the National Health Insurance Research Database. Subjects receiving home palliative care, from 2010 to 2012, were analyzed to evaluate the association between a home death and various characteristics related to illness, individual, and health care utilization. A multiple-logistic regression model was used to assess the independent effect of various characteristics on the likelihood of a home death.The overall rate of a home death for home palliative care recipients was 43.6%. Age; gender; urbanization of the area where the patients lived; illness; the total number of home visits by all health care professionals; the number of home visits by nurses; utilization of nasogastric tube, endotracheal tube, or indwelling urinary catheter; the number of emergency department visits; and admission to intensive care unit in previous 1 year were not significantly associated with the risk of a home death. Physician home visits increased the likelihood of a home death. Compared with subjects without physician home visits (31.4%) those with 1 physician home visit (53.0%, adjusted odds ratio [AOR]: 3.23, 95% confidence interval [CI]: 1.93-5.42) and those with ≥2 physician home visits (43.9%, AOR: 2.23, 95% CI: 1.06-4.70) had higher likelihood of a home death. Compared with subjects with hospitalization 0 to 6 times in previous 1 year, those with hospitalization ≥7 times in previous 1 year (AOR: 0.57, 95% CI: 0.34-0.95) had lower likelihood of a home death.Among home palliative care recipients, physician home visits increased the likelihood of a home death. Hospitalizations ≥7 times in previous 1 year decreased the likelihood of a home death.
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Affiliation(s)
- Ming-Chung Ko
- Department of Urology, Taipei City Hospital, Taipei City
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City
- School of Medicine, Fu-Jen Catholic University, New Taipei City
| | - Sheng-Jean Huang
- Superintendent Office, Taipei City Hospital, Taipei City
- Department of Surgery, National Taiwan University, Taipei City
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City
| | - Yu-Ping Chang
- Center of Quality Management, Taipei City Hospital, Taipei City
| | - Hsin-Yi Lien
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City
- Cross-Strait Medical and Management Communication Center, Taipei City Hospital, Taipei City
| | - Jia-Yi Lin
- Administrative Center, Ministry of Health and Welfare Taipei Hospital, New Taipei City
| | - Lin-Chung Woung
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City
- Superintendent Office, Taipei City Hospital, Taipei City
| | - Shang-Yih Chan
- Department of Cardiology, Taipei City Hospital, Taipei City, Taiwan
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16
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Nilsson J, Blomberg C, Holgersson G, Carlsson T, Bergqvist M, Bergström S. End-of-life care: Where do cancer patients want to die? A systematic review. Asia Pac J Clin Oncol 2017; 13:356-364. [DOI: 10.1111/ajco.12678] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 01/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jonas Nilsson
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Radiation Sciences & Oncology; Umeå University Hospital; Umeå Sweden
- Department of Radiology; Gävle Hospital; Gävle Sweden
| | - Carl Blomberg
- Department of Oncology; Gävle Hospital; Gävle Sweden
| | - Georg Holgersson
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Oncology; Gävle Hospital; Gävle Sweden
| | - Tobias Carlsson
- Department of Radiation Sciences & Oncology; Umeå University Hospital; Umeå Sweden
| | - Michael Bergqvist
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Oncology; Gävle Hospital; Gävle Sweden
- Department of Radiation Sciences & Oncology; Umeå University Hospital; Umeå Sweden
| | - Stefan Bergström
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Oncology; Gävle Hospital; Gävle Sweden
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Kato K, Fukuda H. Comparative economic evaluation of home-based and hospital-based palliative care for terminal cancer patients. Geriatr Gerontol Int 2017; 17:2247-2254. [PMID: 28181371 DOI: 10.1111/ggi.12977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/02/2016] [Accepted: 11/11/2016] [Indexed: 11/27/2022]
Abstract
AIM To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. METHODS We carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care. RESULTS The case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18-36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12-10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53-46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11-29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97-34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59-1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093-7991, P = 0.015) in treatment costs. CONCLUSIONS Despite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247-2254.
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Affiliation(s)
- Koki Kato
- Madoka Family Clinic, Fukuoka, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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18
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Costa V, Earle CC, Esplen MJ, Fowler R, Goldman R, Grossman D, Levin L, Manuel DG, Sharkey S, Tanuseputro P, You JJ. The determinants of home and nursing home death: a systematic review and meta-analysis. BMC Palliat Care 2016; 15:8. [PMID: 26791258 PMCID: PMC4721064 DOI: 10.1186/s12904-016-0077-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 01/06/2016] [Indexed: 11/15/2022] Open
Abstract
Background Most Canadians die in hospital, and yet, many express a preference to die at home. Place of death is the result of the interaction among sociodemographic, illness- and healthcare-related factors. Although home death is sometimes considered a potential indicator of end-of-life/palliative care quality, some determinants of place of death are more modifiable than others. The objective of this systematic review was to evaluate the determinants of home and nursing home death in adult patients diagnosed with an advanced, life-limiting illness. Methods A systematic literature search was performed for studies in English published from January 1, 2004 to September 24, 2013 that evaluated the determinants of home or nursing home death compared to hospital death in adult patients with an advanced, life-limiting condition. The adjusted odds ratios, relative risks, and 95 % confidence intervals of each determinant were extracted from the studies. Meta-analyses were performed if appropriate. The quality of individual studies was assessed using the Newcastle-Ottawa scale and the body of evidence was assessed according to the GRADE Working Group criteria. Results Of the 5,900 citations identified, 26 retrospective cohort studies were eligible. The risk of bias in the studies identified was considered low. Factors associated with an increased likelihood of home versus hospital death included multidisciplinary home palliative care, preference for home death, cancer as opposed to other diagnoses, early referral to palliative care, not living alone, having a caregiver, and the caregiver’s coping skills. Conclusions Knowledge about the determinants of place of death can be used to inform care planning between healthcare providers, patients and family members regarding the feasibility of dying in the preferred location and may help explain the incongruence between preferred and actual place of death. Modifiable factors such as early referral to palliative care, presence of a multidisciplinary home palliative care team were identified, which may be amenable to interventions that improve the likelihood of a patient dying in the preferred location. Place of death may not be a very good indicator of the quality of end-of-life/palliative care since it is determined by multiple factors and is therefore dependent on individual circumstances. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0077-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vania Costa
- Health Quality Ontario, 130 Bloor Street West, 10th floor, Toronto, M5S 1 N5, ON, Canada.
| | - Craig C Earle
- Ontario Institute for Cancer Research, 101 College Street, Toronto, M5G 1 L7, ON, Canada
| | - Mary Jane Esplen
- de Souza Institute, University Health Network, 700 Bay Street, 19th floor, Toronto, M5G 1Z6, ON, Canada
| | - Robert Fowler
- Department of Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, M4N 3M5, ON, Canada
| | - Russell Goldman
- Mount Sinai Hospital, Tammy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, L4-000, Toronto, M5T 3 L9, ON, Canada
| | - Daphna Grossman
- North York General Hospital, 4001 Leslie Street, Toronto, M2K 1E1, ON, Canada
| | - Leslie Levin
- MaRS Discovery District, 101 College Street, Toronto, M5G 1 L7, ON, Canada
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, K1Y 4E9, ON, Canada
| | - Shirlee Sharkey
- Saint Elizabeth Health Care , 90 Allstate Parkway, Suite 300, Markham, L3R 6H3, ON, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, K1Y 4E9, ON, Canada
| | - John J You
- Departments of Medicine, and Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, L8S 4 K1, ON, Canada
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Igarashi A, Kurinobu T, Ko A, Okamoto Y, Matsuura S, Feng M, Yamamoto-Mitani N. Factors related to the provision of home-based end-of-life care among home-care nursing, home help, and care management agencies in Japan. BMC Res Notes 2015; 8:434. [PMID: 26364196 PMCID: PMC4567792 DOI: 10.1186/s13104-015-1418-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 09/07/2015] [Indexed: 02/05/2023] Open
Abstract
Background To promote home death, it is necessary to clarify the institutional barriers to conducting end-of-life (EOL) care and consider strategies to deal with this process. This study aims to clarify institution-related factors associated with the provision of home-based EOL care cases, and to compare them among three different types of home-care agencies. Methods We administered a cross-sectional survey throughout Japan to investigate the number and characteristics of EOL cases of home-care nursing (HN), home-help (HH) and care management (CM) agencies. Bivariate and multivariate analyses were performed for each type of agency to examine factors related to the provision of EOL care. Results 378 HN agencies, 274 HH agencies, and 452 CM agencies responded to the distributed questionnaire. HN agencies had on average
2.1 (SD = 4.0; range 0–60) home-based EOL cases in the last 3 months, while HH agencies had 0.9 (SD = 1.3; range 0–7) and CM agencies had 1.5 (SD = 2.2; range 0–18) in the last 6 months. In a multivariable analysis of HN agencies, a large number of staff (OR: 1.52; p < 0.001) and a large number of collaborating CM agencies (OR: 1.08; p = 0.008) were positively associated with the provision of EOL care; in HH agencies, accepting EOL clients in the agency (OR: 3.29; p < 0.001) was positively associated with the provision of EOL care; in CM agencies, the number of staff (OR: 1.21; p = 0.037), the number of collaborating HH agencies (OR: 1.07; p = 0.032), and whether home-care nurses and home helpers visit clients together (OR: 1.89; p = 0.007) were positively associated with the provision of EOL care. Conclusion The agency’s size and the inter-agency collaborative system seemed most important among HN agencies and CM agencies, while institutional preparedness for EOL was most important for HH agencies. These findings represent important new information for targeting different effective strategies in the promotion of home-based EOL care, depending on the agency type.
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Affiliation(s)
- Ayumi Igarashi
- School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Takeshi Kurinobu
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Ayako Ko
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Yuko Okamoto
- Faculty of Nursing, Japanese Red Cross College of Nursing, 4-1-3 Hiroo, Shibuya-ku, Tokyo, 150-0012, Japan.
| | - Shino Matsuura
- Department of Nursing, Faculty of Human Sciences, Sophia University, 7-1 Kioicho, Chiyoda-ku, Tokyo, 102-8554, Japan.
| | - Mei Feng
- Intensive Care Unit, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
| | - Noriko Yamamoto-Mitani
- School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Guerriere D, Husain A, Marshall D, Zagorski B, Seow H, Brazil K, Kennedy J, McLernon R, Burns S, Coyte PC. Predictors of Place of Death for Those in Receipt of Home-Based Palliative Care Services in Ontario, Canada. J Palliat Care 2015. [PMID: 26201209 DOI: 10.1177/082585971503100203] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many cancer patients die in institutional settings despite their preference to die at home. A longitudinal, prospective cohort study was conducted to comprehensively assess the determinants of home death for patients receiving home-based palliative care. Data collected from biweekly telephone interviews with caregivers (n = 302) and program databases were entered into a multivariate logistic model. Patients with high nursing costs (odds ratio [OR]: 4.3; confidence interval [CI]: 1.8-10.2) and patients with high personal support worker costs (OR: 2.3; CI: 1.1-4.5) were more likely to die at home than those with low costs. Patients who lived alone were less likely to die at home than those who cohabitated (OR: 0.4; CI: 0.2-0.8), and those with a high propensity for a home-death preference were more likely to die at home than those with a low propensity (OR: 5.8; CI: 1.1-31.3). An understanding of the predictors of place of death may contribute to the development of effective interventions that support home death.
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21
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Costa V. The Determinants of Place of Death: An Evidence-Based Analysis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2014; 14:1-78. [PMID: 26351550 PMCID: PMC4561767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND According to a conceptual model described in this analysis, place of death is determined by an interplay of factors associated with the illness, the individual, and the environment. OBJECTIVES Our objective was to evaluate the determinants of place of death for adult patients who have been diagnosed with an advanced, life-limiting condition and are not expected to stabilize or improve. DATA SOURCES A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2004, to September 24, 2013. REVIEW METHODS Different places of death are considered in this analysis-home, nursing home, inpatient hospice, and inpatient palliative care unit, compared with hospital. We selected factors to evaluate from a list of possible predictors-i.e., determinants-of death. We extracted the adjusted odds ratios and 95% confidence intervals of each determinant, performed a meta-analysis if appropriate, and conducted a stratified analysis if substantial heterogeneity was observed. RESULTS From a literature search yielding 5,899 citations, we included 2 systematic reviews and 29 observational studies. Factors that increased the likelihood of home death included multidisciplinary home palliative care, patient preference, having an informal caregiver, and the caregiver's ability to cope. Factors increasing the likelihood of a nursing home death included the availability of palliative care in the nursing home and the existence of advance directives. A cancer diagnosis and the involvement of home care services increased the likelihood of dying in an inpatient palliative care unit. A cancer diagnosis and a longer time between referral to palliative care and death increased the likelihood of inpatient hospice death. The quality of the evidence was considered low. LIMITATIONS Our results are based on those of retrospective observational studies. CONCLUSIONS The results obtained were consistent with previously published systematic reviews. The analysis identified several factors that are associated with place of death.
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Mercadante S, Valle A, Porzio G, Aielli F, Adile C, Casuccio A. Prognostic factors of survival in patients with advanced cancer admitted to home care. J Pain Symptom Manage 2013; 45:56-62. [PMID: 23017625 DOI: 10.1016/j.jpainsymman.2011.12.288] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 12/22/2011] [Accepted: 12/31/2011] [Indexed: 11/18/2022]
Abstract
CONTEXT Data regarding prognostication of life expectancy in patients with advanced cancer are of paramount importance to patients, families, and clinicians. However, data regarding patients followed at home are lacking. OBJECTIVES The aim of this study was to evaluate the correlation between various factors recorded at the beginning of home care assistance and survival. METHODS A sample of consecutive patients admitted to two home care programs was surveyed. A preliminary consensus was achieved as to the possible variables easy to be recorded at home. These included age at the time of home care admission, gender, residence, marital status, primary cancer diagnosis, Karnofsky Performance Status (KPS) score, measures of systolic blood pressure and heart rate, cyanosis, use of oxygen, and body temperature. The Edmonton Symptom Assessment System was used to record the intensity of each symptom. Patients were divided into two groups: patients with a survival of less than 10 days (short survival) and patients with a survival of 10 days or more (medium-long survival). RESULTS Three hundred seventy-four consecutive patients admitted to home care programs were surveyed, of which 187 were male. The mean±SD age was 72.1±12.7 years. The mean survival was 56.2±65 days. Mean survival was 71.5±67 days (287 patients) and 5.6±2.7 days (87 patients) in the short and medium-long survival groups, respectively. No association between type of tumor and survival was observed (P=0.162). Univariate logistic regression analysis revealed that male gender (P=0.020), older age (P=0.012), lower KPS scores (P<0.0005), systolic blood pressure less than 100 mmHg (P=0.003), heart rate greater than 100 beats per minute (P=0.0006), delirium (P=0.004), the use of oxygen (P=0.002), intensity of fatigue (P=0.006), drowsiness (P<0.0005), anorexia (P<0.0005), dyspnea (P<0.0005), poor sense of well-being (P<0.0005), and distress score (P<0.0005) were associated with a survival of less than 10 days. Marital status, residence, cognitive function, fever, pain, depression, and anxiety were not found to be significantly correlated with survival. In a multiple logistic regression model, low systolic blood pressure and high heart rate, gender, delirium, use of oxygen, KPS score, drowsiness, anorexia, and dyspnea were significantly correlated with a shorter survival. CONCLUSION Low systolic blood pressure and high heart rate, male gender, poor KPS score, anorexia, and dyspnea were correlated with a shorter survival. Moreover, patients with low systolic blood pressure and high heart rate, male gender, poor KPS score, and greater intensity of anorexia and dyspnea are more likely to die within one week. The combination of physical symptoms from the Edmonton Symptom Assessment System and other parameters included in this study, which are simple to assess and are repeatable at home, should be further explored in future studies to provide a simple tool for use with patients with advanced cancer admitted to a home care program.
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Fukui S, Yoshiuchi K. Associations with the Japanese population's preferences for the place of end-of-life care and their need for receiving health care services. J Palliat Med 2012; 15:1106-12. [PMID: 22788951 DOI: 10.1089/jpm.2012.0034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aims of this study were to identify the associations with the Japanese population's preferences for the place of end-of-life care and their need for receiving health care services. METHODS A secondary analysis of a cross-sectional nationwide survey was conducted for 2000 randomly selected Japanese people aged 40-79 years. RESULTS A total of 1042 people (55%) responded. Regarding preferred place of care, we set the place within the choices of "Home" (preferred by 44% of respondents), "Acute Hospital" (15%), "Palliative Care Unit" (19%), "Public Nursing Home" (10%), and "Private Nursing Home" (2%). Multinomial logistic regression analysis revealed that the people who preferred "Acute Hospital" tended to have the following need compared to those who preferred "Home," "Palliative Care Unit," or "Nursing Home": higher need for receiving end-of-life care not from its experienced professionals but from the same staff; higher need for using health care services in highly supported environment such as the need for being near health care staff whenever and for receiving treatment possibly until the end; and higher need for consulting nurses whenever. They had lower need for using home care services and daycare services and also lower need for instructing families about how to use insurance/public health services. CONCLUSIONS The present findings may help to develop an effective end-of-life care system in Japan considering Japanese people's need for health care services. Also, the results of this study may underscore the importance of education on receiving home care services especially for the people who presently prefer the hospital for end-of-life care.
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Affiliation(s)
- Sakiko Fukui
- Department of Community Health Nursing, Graduate School of Nursing, The Japanese Red Cross University, Shibuya-ku, Tokyo, Japan.
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