Abstract
Background Meeting patients' preferences for place of care at the end-of-life is an indicator of quality palliative care. Understanding the elements required for terminal care within an integrated model may inform policy and practice to increase the likelihood of meeting preferences. Hence, this study aims to identify factors associated with the final place of care of advanced cancer patients receiving integrated home-based palliative care.MethodsThis retrospective cohort study included deceased adult advanced cancer patients enrolled into the home-based service from January 2016-December 2018. Patients with <2 weeks enrolment or ≤1-week duration at the final place of care were excluded. Independent variables included patients’ and families’ characteristics, care preferences, healthcare utilization, functional status and symptom severity assessed using the Palliative Performance Scale (PPSv2) and the Edmonton Symptom Assessment System respectively. The dependent variable was the final place of care. Multivariate logistic regression identified independent determinants and Kappa value evaluated goal-concordance.ResultsOf the 359 eligible patients, home was the most common final place of care (58.2%), followed by inpatient hospice (23.7%) and hospital (16.7%). Single or divorced patients with older family caregivers had a 5.5 (95% CI:1.1-27.8) and 3.1 (95% CI:1.1-8.8) odds respectively of receiving terminal care in inpatient hospice. A PPSv2≥40% and pain score ≥2 increased the odds by 9.1 (95% CI:3.3-24.8) and 3.6 (95% CI:1.3-9.8) times respectively, while non-home death preference increased it by 23.8 (95% CI:5.4-105.1) times. In predicting hospitalization, males had a 3.2 (95% CI:1.0-9.9) odds while a PPSv2≥40% and pain score ≥2 increased the odds by 8.6 (95% CI:2.9-26.0) and 3.5 (95% CI:1.2-10.3) times respectively. Non-home death preference increased it by 9.8 (95% CI:2.1-46.3) times, all p<0.05. Goal-concordance was fair (72.6%, kappa=0.39).ConclusionsHigher 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 inpatient hospice while males were more likely to be hospitalized. Despite an integrated care model, goal-concordance was suboptimal. More comprehensive community networks and resources, better pain control and personalized care planning discussions are recommended. Future research could examine factors in non-cancer patients.
Effectiveness of the Online Daily Diary (ONDIARY) program on family caregivers of advanced cancer patients: A home-based palliative care trial
