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Cheon J, Kim DH, Cho CM. Factors associated with home death in South Korea: Using the exit data from the Korean Longitudinal Study of Aging, 2008-2018. PLoS One 2023; 18:e0288165. [PMID: 37450472 PMCID: PMC10348527 DOI: 10.1371/journal.pone.0288165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Even though home deaths have been reported to improve quality of life, satisfy patients and families, and reduce healthcare expenditures, not enough is known about the factors that influence home deaths in Korea. OBJECTIVES This study aimed to examine the factors associated with home deaths among middle-aged and older adults in South Korea. METHODS This secondary data analysis used core interview and exit interview data of the Korean Longitudinal Study of Aging conducted between 2008 and 2018. The deceased included adults over the age of 45 years. The exit data were obtained from interviews with family members or other acquaintances known to the deceased every two years since 2008. Complex-sample logistic regression was conducted using 1,565 middle-aged and older deceased adults. RESULTS Among 1,565 decedents, the average age at the time of death was 80.67±10.69 in the home death group, and 78.72±9.83 in the non-home death group. The proportion of home-related deaths was 26.4%. Age over 81 years was associated with increased odds of home death, whereas having two or more living children, living in town/small city, paid medical expenses by children/grandchildren and their spouses, expected death, death from disease, and having three or more chronic diseases were associated with decreased odds of home death. An increase in activities of daily living during three months before death was associated with a decrease in home death. CONCLUSION The findings could help healthcare professionals develop tailored interventions to help people die at their preferred place of death based on family characteristics and healthcare accessibility. Age, residential area, number of children and children's financial support, and illness-related factors influenced home death by creating differences in access to healthcare resources and support. Policymakers should decrease healthcare disparities and improve health resource allocation and home-based care.
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Affiliation(s)
- Jooyoung Cheon
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Dong Hee Kim
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Chung Min Cho
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
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Tam KI, Che SL, Zhu M, Leong SM. Home or hospital as the place of end-of-life care and death: A survey among Chinese residents of Macao. Front Public Health 2023; 11:1043144. [PMID: 36778560 PMCID: PMC9911451 DOI: 10.3389/fpubh.2023.1043144] [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: 09/13/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
Objectives The study was the first to explore Chinese residents' preferred place of care at the end of life and preferred place of death in Macao. Methods A cross-sectional questionnaire survey was conducted online and face-to-face. The questionnaire was designed in Chinese, and both online and face-to-face surveys were conducted in Chinese. The study was conducted in Macao. Macao residents aged 18 years and older were recruited. Results A total of 737 responses were valid, 65% were female, aged between 19 and 101 years; 43.4% of respondents preferred to be cared for at home in the last 6 months; however, less than one-fifth preferred to die at home. One-third of respondents chose to die in the hospice, and over a quarter of them preferred to die in hospitals. Compared with people aged between 18 and 39 years, people aged between 40 and 64 years did not want to be cared for at home in the last 6 months, and they did not want to die at home either. Conclusion The results of the study suggested that there is a need for palliative home care in Macao, and the government should consider developing such a service and review current laws and regulations in supporting the service. Education is equally important for healthcare professionals, enabling them to support palliative care development in the community.
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Nguyen PT, Liaw SY, Tan AJQ, Rusli KDB, Tan LLC, Goh HS, Chua WL. “Nurses caught in the middle”: A qualitative study of nurses’ perspectives on the decision to transfer deteriorating nursing home residents to emergency departments in Singapore. Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang W, Liu Y, Ye P, Liu J, Yin P, Qi J, You J, Lin L, Wang F, Wang L, Huo Y, Zhou M. Trends and associated factors in place of death among individuals with cardiovascular disease in China, 2008-2020: A population-based study. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 21:100383. [PMID: 35540560 PMCID: PMC9079349 DOI: 10.1016/j.lanwpc.2022.100383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death (COD) in China. Understanding the characteristics of place of death (POD) among CVD deaths would be of great importance to evaluate the healthcare service utilization at the end stage of life. Limited studies have reported the POD distribution among CVD deaths, and little was known about the associated factors of hospital CVD deaths. Methods By using data from National Mortality Surveillance System (NMSS) in China, this study presented the characteristics of POD distribution during 2008 and 2020. Afterwards, multilevel logistic regression was used to explore associated factors of hospital CVD deaths and quantify the magnitude to which the spatial variations of hospital CVD deaths could be explained by those associated factors. Findings During 2008-2020, there was 7101871 CVD deaths collected by NMSS in China, with 77·13% home deaths and 18·49% hospital deaths. Shanghai (59·40%) had the highest percentage of hospital CVD deaths. Age, sex, ethnicity, marital status, education, occupation, underlying COD were significant influential factors of hospital CVD deaths. Spatial variations were shown at provincial level, with 33·88% of them being explained by factors at individual level. Interpretation Home was the leading POD among CVD deaths in China, those CVD decedents characterized as the female, the youngest, Han population, the married, the retiree, lived in urban areas, with higher socioeconomic status and died of chronic CVDs had a higher probability of hospital deaths. Providing accessible and available healthcare services were priorities to improve quality of end-of-life care, significant variations among provinces and sub-population also reminded us of the requirements for equal healthcare resources allocation and multiple options for minorities of POD preference at the end stage of life. Funding National Key Research & Development Program of China (grant number 2018YFC1315301)
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Affiliation(s)
- Wei Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Pengpeng Ye
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinling You
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lin Lin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feixue Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Prof. Yong Huo, Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China, Tel: 010-83575725, Fax: 010-66551211
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Correspondence to Prof. Maigeng Zhou, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing, 100050, China, Tel: 86-10-63041471, Fax: 86-10-63042350.
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Di Nitto M, Artico M, Piredda M, De Maria M, Magnani C, Marchetti A, Mastroianni C, Latina R, De Marinis MG, D’Angelo D. Factors influencing place of death and disenrollment among patients receiving specialist palliative care. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022189. [PMID: 35545986 PMCID: PMC9534221 DOI: 10.23750/abm.v93is2.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Place of death and disenrollment from specialized palliative care services (SPCSs) are two aspects that determine service utilization. These aspects should be determined by patient needs and preferences, but they are often associated to patient sociodemographic or contextual characteristics. The aim of this study was to describe which factors are associated with utilizing SPCSs in terms of place of death and disenrollment. METHODS Retrospective cohort study. Patients (>18 years) who died or were disenrolled during SPCSs utilization. Two hierarchical regression models were performed, and variables were categorized in predisposing, enabling, and need factors according to the Andersen behavioral model of health services use. RESULTS We included 35,869 patients (52,5% male, mean age 74,6 ± 12,3 SD), where 17,225 patients died in hospice and 16,953 at home, while 1,691 patients were disenrolled. Dying at home was associated with older age, oncological diagnosis, painful symptoms and longer survival time. Instead, service disenrollment was associated with less education, longer wait time and longer length of stay. CONCLUSIONS SPCS utilization was not influenced only by patient need, but also by other factors, such as social and contextual factors. These factors need to be considered by health care providers and efforts are needed for 1) identifying barriers and implementing effective interventions to support patients and caregivers in their preferred place of care and death and 2) for avoiding SPCS disenrollment with an increased probability of aggressive treatments and worse quality of life for patients.
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Affiliation(s)
- Marco Di Nitto
- Department of biomedicine and prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Marco Artico
- Department of Palliative Care and Pain Therapy Unit, Azienda ULSS n.4 Veneto Orientale, San Donà di Piave, Italy
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Maddalena De Maria
- Department of biomedicine and prevention, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | | | - Roberto Latina
- Deptment of Health Promotion Sciences, Maternal & Infant Care, Internal Medicine & Excellence Specialists University of Palermo, Palermo, Italy
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Predictors of At-Home Death for Cancer Patients in Rural Clinics in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312703. [PMID: 34886428 PMCID: PMC8656844 DOI: 10.3390/ijerph182312703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The prediction of at-home deaths has become an important topic in rural areas of Japan with an advanced aging society. However, there are no well-established predictors to explain how these factors influence intention. This study aims to investigate the possible predictors of at-home death for cancer patients in rural clinics in Japan. METHODS This is a nationwide cross-sectional survey. A self-administered questionnaire was sent to 493 rural clinics in Japan. The main outcome was the realization of at-home deaths for cancer patients. RESULTS Among the 264 clinics (54%) that responded to the survey, there were 194 clinics with the realization of at-home death. The use of a clinical pathway (adjusted odds ratio 4.19; 95% confidence interval 1.57-11.19) and the provision of organized palliative care (adjusted odds ratio 19.16; 95% confidence interval 7.56-48.52) were associated with the prediction of at-home death, irrespective of island geography or the number of doctors and nurses. CONCLUSIONS Having a clinical pathway and systematizing palliative care could be important to determine the possibility of at-home deaths for cancer patients in rural clinics in Japan.
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Zhuang Q, Chan JSE, See LKY, Chiang J, Suhaimi SR, Chua TWL, Venkataraman A. Characteristics of unplanned hospitalisations among cancer patients in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:882-891. [PMID: 34985100 DOI: 10.47102/annals-acadmedsg.2021212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Cancer is a pervasive global problem with significant healthcare utilisation and cost. Emergency departments (EDs) see large numbers of patients with oncologic emergencies and act as "gate-keepers" to subsequent hospital admissions. A proportion of such hospital admissions are rapidly discharged within 2 days and may be potentially avoidable. METHODS Over a 6-month period, we conducted a retrospective audit of active cancer patients presenting to the ED with subsequent admission to the Department of Medical Oncology. Our aims were to identify independent factors associated with a length of stay ≤2 days; and characterise the clinical and resource needs of these short admissions. RESULTS Among all medical oncology admissions, 24.4% were discharged within 2 days. Compared to longer stayers, patients with short admissions were significantly younger (P=0.010), had lower National Early Warning Scores (NEWS) (P=0.006), and had a lower proportion of gastrointestinal and hepatobiliary cancers (P=0.005). Among short admissions, common presenting medical problems were infections (n=144, 36.3%), pain (n=116, 29.2%), gastrointestinal complaints (n=85, 21.4%) and respiratory complaints (n=76, 19.1%). These admissions required investigations and treatments already available at the ED. CONCLUSION Short admissions have low resource needs and may be managed in the ED. This may help save valuable inpatient bed-days and reduce overall healthcare costs.
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Affiliation(s)
- Qingyuan Zhuang
- Division of Supportive and Palliative Care, National Cancer Centre, Singapore
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Predictors of the final place of care of patients with advanced cancer receiving integrated home-based palliative care: a retrospective cohort study. BMC Palliat Care 2021; 20:164. [PMID: 34663303 PMCID: PMC8522009 DOI: 10.1186/s12904-021-00865-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Meeting patients’ preferences for place of care at the end-of-life is an indicator of quality palliative care. Understanding the key elements required for terminal care within an integrated model may inform policy and practice, and consequently increase the likelihood of meeting patients’ preferences. Hence, this study aimed to identify factors associated with the final place of care in patients with advanced cancer receiving integrated, home-based palliative care. Methods This retrospective cohort study included deceased adult patients with advanced cancer who were enrolled in the home-based palliative care service between January 2016 and December 2018. Patients with < 2 weeks’ enrollment in the home-based service, or ≤ 1-week duration at the final place of care, were excluded. The following information were retrieved from patients’ electronic medical records: patients’ and their families’ characteristics, care preferences, healthcare utilization, functional status (measured by the Palliative Performance Scale (PPSv2)), and symptom severity (measured by the Edmonton Symptom Assessment System). Multivariate logistic regression was employed to identify independent predictors of the final place of care. Kappa value was calculated to estimate the concordance between actual and preferred place of death. Results A total of 359 patients were included in the study. Home was the most common (58.2%) final place of care, followed by inpatient hospice (23.7%), and hospital (16.7%). Patients who were single or divorced (OR: 5.5; 95% CI: 1.1–27.8), or had older family caregivers (OR: 3.1; 95% CI: 1.1–8.8), PPSv2 score ≥ 40% (OR: 9.1; 95% CI: 3.3–24.8), pain score ≥ 2 (OR: 3.6; 95% CI: 1.3–9.8), and non-home death preference (OR: 23.8; 95% CI: 5.4–105.1), were more likely to receive terminal care in the inpatient hospice. Patients who were male (OR: 3.2; 95% CI: 1.0–9.9), or had PPSv2 score ≥ 40% (OR: 8.6; 95% CI: 2.9–26.0), pain score ≥ 2 (OR: 3.5; 95% CI: 1.2–10.3), and non-home death preference (OR: 9.8; 95% CI: 2.1–46.3), were more likely to be hospitalized. Goal-concordance was fair (72.6%, kappa = 0.39). Conclusions Higher functional status, greater pain intensity, and non-home death preference predicted institutionalization as the final place of care. Additionally, single or divorced patients with older family caregivers were more likely to receive terminal care in the inpatient hospice, while males were more likely to be hospitalized. Despite being part of an integrated care model, goal-concordance was sub-optimal. More comprehensive community networks and resources, enhanced pain control, and personalized care planning discussions, are recommended to better meet patients’ preferences for their final place of care. Future research could similarly examine factors associated with the final place of care in patients with advanced non-cancer conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00865-5.
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A Comparison of the Survival, Place of Death, and Medical Utilization of Terminal Patients Receiving Hospital-Based and Community-Based Palliative Home Care: A Retrospective and Propensity Score Matching Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147272. [PMID: 34299722 PMCID: PMC8307712 DOI: 10.3390/ijerph18147272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 12/17/2022]
Abstract
Evidence shows that community-based palliative home care (PHC) provision enhances continuous care and improves patient outcomes. This study compared patient survival, place of death, and medical utilization in community- versus hospital-based PHC. A retrospective cohort study was conducted of patients aged over 18 referred to either community- or hospital-based PHC from May to December 2018 at a tertiary hospital and surrounding communities in Southern Taiwan. A descriptive analysis, Chi-square test, t-test, and Log-rank test were used for the data analysis of 131 hospital-based PHC patients and 43 community-based PHC patients, with 42 paired patient datasets analyzed after propensity score matching. More nurse visits (p = 0.02), fewer emergency-room visits (p = 0.01), and a shorter waiting time to access PHC (p = 0.02) were found in the community group. There was no difference in the duration of survival and hospitalization between groups. Most hospital-based patients (57%) died in hospice wards, while most community-based patients died at home (52%). Community-based PHC is comparable to hospital-based PHC in Taiwan. Although it has fewer staffing and training requirements, it is an alternative for terminal patients to meet the growing end-of-life care demand.
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Rottenberg Y, Goldzweig G, Shaulov A. Predictors of death at home among cancer patients in Israel: a population-based study. Int J Equity Health 2021; 20:99. [PMID: 33838680 PMCID: PMC8037835 DOI: 10.1186/s12939-021-01437-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most cancer patients prefer to die at home; however, many die in hospital. The aim of the current study is to elucidate the association between dying at home and various personal factors in the Israeli population of cancer patients. METHODS Data on cancer incidence (2008-2015) and death (2008-2017) was provided by the Israeli Central Bureau of Statistics and the Israel National Cancer Registry. Binary logistic regression analyses were performed to assess odds ratios for death at home following cancer diagnosis while controlling for age, sex, ethnicity, years of education, residential socioeconomic score, and time from diagnosis. We also assessed the relation between place of death and specific cancer sites, as well as the time trend from 2008 to 2017. RESULTS About one quarter (26.7%) of the study population died at home. Death at home was most frequent among patients diagnosed with brain tumors (37.0%), while it was the lowest among patients with hematologic malignancies (lymphoma and leukemia, 20.3 and 20.0%, respectively). Rates of dying at home among patients with residential socioeconomic scores of 1, 2-9, and 10 were about 15, 30, and 42.9%, respectively. In patients from the 4th to the 7th decades of life, rates of death at home increased at a linear rate that increased exponentially from the 8th decade onwards. After controlling for potential confounders, predictive variables for death at home included age (OR = 1.020 per year, 95% CI 1.017-1.024), male sex (OR = 1.18, 95% CI 1.077-1.294), years of education (OR = 1.029 per year, 95% CI 1.018-1.040), and time from diagnosis (OR = 1.003 per month, 95% CI 1.001-1.005 all p < 0.001). No trend was seen from 2008 to 2013, while from 2014 to 2017 a slight increase in the rate of death at home was seen each year. CONCLUSIONS These results indicate wide variability in death at home exists among patients of different ages, sex, education, socioeconomic status and time from diagnosis. These findings stress the importance of delivering quality palliative care at home, mainly for patients with hematologic malignancies, younger patients, and patients of very low socioeconomic status. Understanding the complex mechanisms whereby patient preferences and the above variables may determine the preferred place of death remains an important research priority.
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Affiliation(s)
- Yakir Rottenberg
- Department of Oncology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yafo, Rabenu Yeruham St, 86162, Yaffo, Israel
| | - Adir Shaulov
- Department of Hematology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Cheng SY, Lin CP, Chan HYL, Martina D, Mori M, Kim SH, Ng R. Advance care planning in Asian culture. Jpn J Clin Oncol 2020; 50:976-989. [PMID: 32761078 DOI: 10.1093/jjco/hyaa131] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 07/20/2020] [Indexed: 11/14/2022] Open
Abstract
Ageing has been recognized as one of the most critically important health-care issues worldwide. It is relevant to Asia, where the increasing number of older populations has drawn attention to the paramount need for health-care investment, particularly in end-of-life care. The advocacy of advance care planning is a mean to honor patient autonomy. Since most East Asian countries are influenced by Confucianism and the concept of 'filial piety,' patient autonomy is consequently subordinate to family values and physician authority. The dominance from family members and physicians during a patient's end-of-life decision-making is recognized as a cultural feature in Asia. Physicians often disclose the patient's poor prognosis and corresponding treatment options to the male, family member rather to the patient him/herself. In order to address this ethical and practical dilemma, the concept of 'relational autonomy' and the collectivism paradigm might be ideally used to assist Asian people, especially older adults, to share their preferences on future care and decision-making on certain clinical situations with their families and important others. In this review article, we invited experts in end-of-life care from Hong Kong, Indonesia, Japan, South Korea, Singapore and Taiwan to briefly report the current status of advance care planning in each country from policy, legal and clinical perspectives. According to the Asian experiences, we have seen different models of advance care planning implementation. The Asian Delphi Taskforce for advance care planning is currently undertaken by six Asian countries and a more detailed, culturally sensitive whitepaper will be published in the near future.
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Affiliation(s)
- Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Cheng-Pei Lin
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Central Ave, Hong Kong
| | - Diah Martina
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine Universitas Indonesia, Jakarta Pusat, Indonesia
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sun-Hyun Kim
- Department of Family Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Republic of Korea
| | - Raymond Ng
- Department of Palliative Medicine, Tan Tock Seng Hospital, Jln Tan Tock Seng, Singapore
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Zhuang Q, Lau ZY, Ong WS, Yang GM, Tan KB, Ong MEH, Wong TH. Sociodemographic and clinical factors for non-hospital deaths among cancer patients: A nationwide population-based cohort study. PLoS One 2020; 15:e0232219. [PMID: 32324837 PMCID: PMC7179880 DOI: 10.1371/journal.pone.0232219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Factors associated with place of death inform policies with respect to allocating end-of-life care resources and tailoring supportive measures. OBJECTIVE To determine factors associated with non-hospital deaths among cancer patients. DESIGN Retrospective cohort study of cancer decedents, examining factors associated with non-hospital deaths using multinomial logistic regression with hospital deaths as the reference category. SETTING/SUBJECTS Cancer patients (n = 15254) in Singapore who died during the study period from January 1, 2012 till December 31, 2105 at home, acute hospital, long-term care (LTC) or hospice were included. RESULTS Increasing age (categories ≥65 years: RRR 1.25-2.61), female (RRR 1.40; 95% CI 1.28-1.52), Malays (RRR 1.67; 95% CI 1.47-1.89), Brain malignancy (RRR 1.92; 95% CI 1.15-3.23), metastatic disease (RRR 1.33-2.01) and home palliative care (RRR 2.11; 95% CI 1.95-2.29) were associated with higher risk of home deaths. Patients with low socioeconomic status were more likely to have hospice or LTC deaths: those living in smaller housing types had higher risk of dying in hospice (1-4 rooms apartment: RRR 1.13-3.17) or LTC (1-5 rooms apartment: RRR 1.36-4.11); and those with Medifund usage had higher risk of dying in LTC (RRR 1.74; 95% CI 1.36-2.21). Patients with haematological malignancies had increased risk of dying in hospital (categories of haematological subtypes: RRR 0.06-0.87). CONCLUSIONS We found key sociodemographic and clinical factors associated with non-hospital deaths in cancer patients. More can be done to enable patients to die in the community and with dignity rather than in a hospital.
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Affiliation(s)
- Qingyuan Zhuang
- Department of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- * E-mail:
| | - Zheng Yi Lau
- Policy Research and Evaluation Division, Ministry of Health, Singapore, Singapore
| | - Whee Sze Ong
- National Cancer Centre Singapore, Singapore, Singapore
| | - Grace Meijuan Yang
- Department of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Kelvin Bryan Tan
- Policy Research and Evaluation Division, Ministry of Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Ting Hway Wong
- Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
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Koyama T, Hagiya H, Funahashi T, Zamami Y, Yamagishi M, Onoue H, Teratani Y, Mikami N, Shinomiya K, Kitamura Y, Sendo T, Hinotsu S, Kano MR. Trends in Place of Death in a Super-Aged Society: A Population-Based Study, 1998-2017. J Palliat Med 2020; 23:950-956. [PMID: 32069164 DOI: 10.1089/jpm.2019.0445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Globally, the number of deaths is estimated to increase to 74 million per year by 2030. Place of death (PoD) is increasingly being recognized as an important aspect of end-of-life care. However, recent trends in PoD in Japan, one of the super-aged societies, are unknown. Objective: To analyze trends in PoD in Japan over two decades. Design: Population-based retrospective observational study. Setting: All deaths reported in Japan, 1998-2017. PoD was defined as hospital, nursing home, or own home. Results: All Japanese decedents (∼22.6 million) over the past 20 years were analyzed. The proportion of hospital deaths was consistently high (>80%), with a significant decreasing trend from the mid-2000s. Although the proportion of deaths at home decreased in the first half of the study period, they later increased. There was a low proportion of deaths in nursing homes compared to other places of death; however, the proportion increased continually throughout the study period, particularly among women. In 2015, more women died in nursing homes than at home. Although the proportion of hospital deaths declined in the second half of the study period, their overall number continued to increase, reflecting an increase in total deaths in Japan. Conclusions: This study highlighted rapid changes in trends in PoD in Japan, and the need to consider affordable end-of-life care in Japan as well as other countries with aging populations. The findings from this long-term epidemiological study provide important insights on this issue.
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Affiliation(s)
- Toshihiro Koyama
- Department of Pharmaceutical Biomedicine and Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hideharu Hagiya
- Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tomoko Funahashi
- Department of Pharmaceutical Biomedicine, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Yoshito Zamami
- Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School, Tokushima, Japan
| | - Miyu Yamagishi
- Department of Pharmaceutical Biomedicine and Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hiroshi Onoue
- Department of Pharmaceutical Biomedicine and Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yusuke Teratani
- Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Japan
| | - Naoko Mikami
- Division of Pharmacy, Chiba University Hospital, Chiba, Japan
| | - Kazuaki Shinomiya
- Department of Pharmaceutical Care and Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima, Japan
| | | | - Toshiaki Sendo
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Shiro Hinotsu
- Department of Biostatistics, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Mitsunobu R Kano
- Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School, Tokushima, Japan.,Department of Geriatric Medicine, University of Tokyo, Tokyo, Japan
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