The Impact of Continuous Use of Home Health Care Resources on End-of-Life Care at Home in Older Patients with Cancer: A Retrospective Cohort Study in Fukuoka, Japan

This study aimed at examining the effect of continued use of home health care resources on end-of-life care at home in older patients with cancer. This retrospective cohort study was conducted using medical and long-term care claims data of 6435 older patients with cancer who died between April 2016 and March 2019 in Fukuoka Prefecture. The main explanatory variables were enhanced home care support clinics and hospitals (HCSCs), enhanced HCSCs with beds, conventional HCSCs, other HCSCs, and home visit nursing care. The covariates were sex, age, required level of care, and the Charlson Comorbidity Index. A logistic regression model was used. The results of the multilevel logistic regression analysis showed that the following were significantly associated with end-of-life care at home: use of enhanced HCSCs with beds (odds ratio, OR: 8.66; 95% confidence interval, CI: [4.31-17.40]), conventional HCSCs (OR: 5.78; 95% CI: [1.86-17.94]), enhanced HCSCs (OR: 4.44; 95% CI: [1.47-13.42]), home-visit nursing care (OR: 1.86; 95% CI: [1.42-2.44]), and a severe need for care (OR: 3.89; 95% CI: [2.92-5.18]). The results suggest that the continued use of home health care resources in older patients with cancer who require out-of-hospital care may lead to increased end-of-life care at home. Particularly, use of enhanced HCSCs with beds is most strongly associated with end-of-life care at home.

Anticipated deaths with physician care (mitori) at home in one town in Japan: A preliminary report

Background

There are few reports on the numbers of anticipated deaths (mitori [り]) at home in Japan.

Method

We used the Japanese death certificate system (shiboukohyou []) for Toyono town citizens who died between 2020 and 2022 and judged a death to constitute mitori when the certificate was not written by a doctor referred from the police.

Results

Among 756 deaths, 109 (14.4%) were mitori at home. Deaths at home were 144 and mitori at home accounted for 75.7%.

Conclusion

Shiboukohyou appear to provide numbers of mitori at home. Death certificate should include a space which shows mitori or not.

Effectiveness of transmural team-based palliative care in prevention of hospitalizations in patients at the end of life: A systematic review and meta-analysis

BACKGROUND

Team-based palliative care interventions have shown positive results for patients at the end of life in both hospital and community settings. However, evidence on the effectiveness of transmural, that is, spanning hospital and home, team-based palliative care collaborations is limited.

AIM

To systematically review whether transmural team-based palliative care interventions can prevent hospital admissions and increase death at home.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), PsychINFO (Ovid), and Cochrane Library (Wiley) were systematically searched until January 2021. Studies incorporating teams in which hospital and community professionals co-managed patients, hospital-based teams with community follow-up, and case-management interventions led by palliative care teams were included. Data was extracted by two researchers independently.

RESULTS

About 19 studies were included involving 6614 patients, of whom 2202 received an intervention. The overall pooled odds ratio of at least one hospital (re)admissions was 0.46 (95% confidence interval (CI) 0.34-0.68) in favor of the intervention group. The highest reduction in admission was in the hospital-based teams with community follow-up: OR 0.21 (95% CI 0.07-0.66). The pooled effect on home deaths was 2.19 (95% CI 1.26-3.79), favoring the intervention, with also the highest in the hospital-based teams: OR 4.77 (95% CI 1.23-18.47). However, studies had high heterogeneity regarding intervention, study population, and follow-up time.

CONCLUSION

Transmural team-based palliative care interventions, especially hospital-based teams that follow-up patients at home, show an overall effect on lowering hospital admissions and increasing the number of patients dying at home. However, broad clinical and statistical heterogeneity of included studies results in uncertainty about the effect size.

[The issues behind solitary deaths of older people in central Tokyo]

Objectives　The purpose of this study was to clarify the issues behind the increasing number of solitary deaths of older people in central Tokyo.Methods　In this study a request was made to the national government for information on the 2016 vital statistics survey of ward A, one of the 23 wards of Tokyo. The entries in the death forms do not distinguish between death and post-mortem certificates. However, in the 23 wards where there is a medical examiner system, if the medical institution of the doctor who prepared the post-mortem certificate is the Tokyo-to Medical Examiner's Office, it is possible to identify that the postmortem examination was performed. If the hospital is listed, it is considered a death certificate. A descriptive analytical study was made on the relationship between the cause of death, sex, age and marital status with regard to postmortem examinations of deaths at home or in hospitals resulting from illnesses and home care deaths.Results　Of the 4,429 deaths in Ward A in 2016, 613 were found to be postmortem examinations, of which 436 (71.1%) were of individuals who were 65 years or older. Of the 757 deaths at home, 399 (52.7%) were postmortem examinations, of which 271 were deaths from illness. The number of home care deaths was 358 (47.3%). The mean age of death was 73.6 years for 145 males and 79.5 years for 123 females, out of 268 home deaths of 34 years or older identified as death from illness by postmortem examination. On the other hand, the mean age of death in 358 home care deaths was significantly older as compared to postmortem examination deaths. 65.3% of deaths at home and 54.1% of hospital deaths were due to sudden death-type diseases such as ischemic heart disease. Of the postmortem examination of home deaths from illness among the older people aged 65 years or older, 65.5% of the 110 males and 87.3% of the 110 females were single. Bereavement occurred in 27.3% of men and 52.7% of women, separation in 16.4% of men and 9.1% of women. 21.8% of men and 25.5% of women were never married.Conclusions　In the solitary deaths of older people in central Tokyo, sudden death disease is the direct cause of death and, in the background, there are bereavement from a spouse in women, separation or bereavement from a spouse in men, and being unmarried in both.

Determinants of Home Death in Patients With Cancer: A Population-Based Study in Ontario, Canada

AIM

To determine factors associated with home death in patients with cancer in Ontario, particularly to assess the association between death at home and (1) patients' rural/urban residence and (2) neighborhood income in urban areas.

MATERIALS AND METHODS

We conducted a retrospective cross-sectional study in Ontario (2003-2010) using linked administrative databases. In order to account for clustering phenomenon, multivariable generalized estimating equation model was used to evaluate factors associated with home death. Analysis was performed in both rural and urban areas. For urban areas, neighborhood income was tested as a determinant of the place of death.

RESULTS

A total of 193 783 deaths were analyzed, 9.1% of which occurred at home. In urban areas, home death was more likely for patients living in richer neighborhoods (odds ratio 1.69 for the highest compared to lowest neighborhood income quintile, 95% confidence interval: 1.54-1.86). The odds of dying at home when living in a rural area were no different from those living in the poorest urban neighborhood. Other variables associated with lower odds of home death were comorbidity index, certain cancers, and year of death.

CONCLUSION

The likelihood of dying at home significantly increases with living in higher-income urban neighborhoods and decreases with rural residence. Urban neighborhoods with lowest income have odds of home death similar to rural areas. These findings underline the importance of targeting proper populations for public support at the end of life.

Pediatric Critical Care Transport as a Conduit to Terminal Extubation at Home: A Case Series

OBJECTIVES

To present our single-center's experience with three palliative critical care transports home from the PICU for terminal extubation.

DESIGN

We performed a retrospective chart review of patients transported between January 1, 2012, and December 31, 2014.

SETTING

All cases were identified from our institutional pediatric transport database.

PATIENTS

Patients were terminally ill children unable to separate from mechanical ventilation in the PICU, who were transported home for terminal extubation and end-of-life care according to their families' wishes.

INTERVENTIONS

Patients underwent palliative care transport home for terminal extubation.

MEASUREMENTS AND MAIN RESULTS

The rate of palliative care transports home for terminal extubation during the study period was 2.6 per 100 deaths. The patients were 7 months, 6 years, and 18 years old and had complex chronic conditions. The transfer process was protocolized. The families were approached by the PICU staff during multidisciplinary goals-of-care meetings. Parental expectations were clarified, and home hospice care was arranged pretransfer. All transports were performed by our pediatric critical care transport team, and all terminal extubations were performed by physicians. All patients had unstable medical conditions and urgent needs for transport to comply with the families' wishes for withdrawal of life support and death at home. As such, all three cases presented similar logistic challenges, including establishing do-not-resuscitate status pretransport, having limited time to organize the transport, and coordinating home palliative care services with available community resources.

CONCLUSIONS

Although a relatively infrequent practice in pediatric critical care, transport home for terminal extubation represents a feasible alternative for families seeking out-of-hospital end-of-life care for their critically ill technology-dependent children. Our single-center experience supports the need for development of formal programs for end-of-life critical care transports to include patient screening tools, palliative care home discharge algorithms, transport protocols, and resource utilization and cost analyses.