Impact on place of death in cancer patients: a causal exploration in southern Switzerland

Preference and actual place-of-death in advanced cancer: prospective longitudinal study

OBJECTIVES

To evaluate the preferred place-of-death (PPoD) among patients with advanced cancer over time, and the concordance between preferred and actual place-of-death.

METHODS

Prospective cohort study. A total of 190 patients with advanced cancer and their caregivers (n=190) were interviewed every 3 months, from study enrolment to 12 months (M0, M1, M2, M3, M4). PPoD data were obtained under four different end-of-life scenarios: (1) severe clinical deterioration without further specification; (2) clinical deterioration suffering from severe symptoms; (3) clinical deterioration receiving home-based visits; and (4) clinical deterioration receiving home-based visits and suffering from severe symptoms.

RESULTS

Home was the most common PPoD over time among patients in scenarios 1 (n=121, 63.7%; n=77, 68.8%; n=39, 57.4%; n=30, 62.5%; n=23, 60.5%) and 3 (n=147, 77.4%; n=87, 77.7%; n=48, 70.6%; n=36, 75.0%; n=30, 78.9%). PPoD in palliative care unit (PCU) and hospital were most frequent at baseline in scenario 2 (n=79, 41.6%; n=78, 41.1%), followed by hospital over time (n=61, 54.5%; n=45, 66.2%; n=35, 72.9%; n=28, 73.7%). During the curse of illness, 6.3% of patients change their PPoD in at least one of end-of-life scenario. About 49.7%, 30.6% and 19.7% of patients died in PCU, hospital and home, respectively. Living in rural area (OR=4.21), poor health self-perception (OR=4.49) and pain at the last days of life (OR=2.77) were associated with death in PPoD. The overall agreement between last preference and actual place-of-death was 51.0% (k=0.252).

CONCLUSION

Home death was not the preferred place for a large number of patients when this option was presented within a clinical context scenario. The PPoD and actual place-of-death were depending on the clinical situation.

The use of natural language processing in palliative care research: A scoping review

BACKGROUND

Natural language processing has been increasingly used in palliative care research over the last 5 years for its versatility and accuracy.

AIM

To evaluate and characterize natural language processing use in palliative care research, including the most commonly used natural language processing software and computational methods, data sources, trends in natural language processing use over time, and palliative care topics addressed.

DESIGN

A scoping review using the framework by Arksey and O'Malley and the updated recommendations proposed by Levac et al. was conducted.

SOURCES

PubMed, Web of Science, Embase, Scopus, and IEEE Xplore databases were searched for palliative care studies that utilized natural language processing tools. Data on study characteristics and natural language processing instruments used were collected and relevant palliative care topics were identified.

RESULTS

197 relevant references were identified. Of these, 82 were included after full-text review. Studies were published in 48 different journals from 2007 to 2022. The average sample size was 21,541 (median 435). Thirty-two different natural language processing software and 33 machine-learning methods were identified. Nine main sources for data processing and 15 main palliative care topics across the included studies were identified. The most frequent topic was mortality and prognosis prediction. We also identified a trend where natural language processing was frequently used in analyzing clinical serious illness conversations extracted from audio recordings.

CONCLUSIONS

We found 82 papers on palliative care using natural language processing methods for a wide-range of topics and sources of data that could expand the use of this methodology. We encourage researchers to consider incorporating this cutting-edge research methodology in future studies to improve published palliative care data.

Where do Brazilian cancer patients prefer to die? Agreement between patients and caregivers

Preferred place-of-death (PPoD) is considered an important outcome for the development of appropriate models of care and for improving health policies in countries with underdeveloped palliative care (PC) OBJECTIVES: To determine the concordance between the PPoD of a sample of Brazilian seriously-ill cancer patients and their caregivers, and its associated factors under four different end-of-life (EOL) scenarios: 1) health deterioration in the overall context; 2) health deterioration with severe and uncomfortable symptoms; 3) health deterioration receiving home-based visits as needed; 4) health deterioration receiving home-based visits as needed, when suffering severe and uncomfortable symptoms METHODS: Cross-sectional study at a large Brazilian cancer center, between February 2019 and July 2021. 190 adult cancer patients and their caregivers (n = 190) were analyzed RESULTS: Patient and/or caregiver PPoD concordance for EOL scenario one: 64% vs. 43% for death at home, 22% vs. 30% for death in a PC unit, 14% vs. 27% for death in hospital. Higher patient and/or caregiver PPoD concordance was found for death in hospital (41%; 49%) in EOL scenario two, and for death at home for scenario three (77%; 74%). Agreement coefficient was moderate for scenario two (k = 0.430; P < 0.001), and fair for EOL scenarios one, three and four (k = 0.237, P < 0.001; k = 0.296, P < 0.001; k = 0.307, P < 0.001, respectively). Associated disagreement factors were: performance status (OR:3.03), self-perceived health (OR: 6.99), marital status (OR:2.92), and hospital and/or emergency room proximity (OR:4.11). The presence of relevant persons (42.3% vs. 44.2%), followed by spirituality (38.5% vs. 27.9%) and the place-of-death (14.0% vs. 18.4%), were the most important factors in the EOL, when comparing patients and care givers opinions, respectively CONCLUSION: Low agreement between patients and caregivers on PPoD was identified. EOL clinical factors and deterioration, and PC support seem to influence PPoD.

Preferred Place of Death in Adult Cancer Patients: A Systematic Review and Meta-Analysis

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.