Factors associated with the accomplishment of home death among patients receiving physician‐led home healthcare

Purpose The purpose of this study was to identify factors associated with at-home death among patients with advanced cancer and create a decision-making model for discharging patients from an acute-care hospital. Patients and Methods We conducted an observational cohort study to identify the association between place of death and the clinical and demographic characteristics of patients with advanced cancer who received care from a palliative home care team (PHCT) and of their primary caregivers. We used logistic regression analysis to identify the predictors of at-home death. Results We identified 380 patients who met the study inclusion criteria; of these, 245 patients (64%) died at home, 72 (19%) died in an acute-care hospital, 60 (16%) died in a palliative care unit, and three (1%) died in a nursing home. Median follow-up was 48 days. We included the 16 variables that were significant in univariate analysis in our decision-making model. Five variables predictive of at-home death were retained in the multivariate analysis: caregiver's preferred place of death, patients' preferred place of death, caregiver's perceived social support, number of hospital admission days, and number of PHCT visits. A subsequent reduced model including only those variables that were known at the time of discharge (caregivers' preferred place of death, patients' preferred place of death, and caregivers' perceived social support) had a sensitivity of 96% and a specificity of 81% in predicting place of death. Conclusion Asking a few simple patient- and family-centered questions may help to inform the decision regarding the best place for end-of-life care and death.

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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 Palliative Care ◽

10.1186/s12904-021-00865-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Ri Yin Tay ◽

Rozenne W. K. Choo ◽

Wah Ying Ong ◽

Allyn Y. M. Hum

Keyword(s):

Palliative Care ◽

Cohort Study ◽

Family Caregivers ◽

Advanced Cancer ◽

Terminal Care ◽

Retrospective Cohort ◽

Home Death ◽

Factors Associated ◽

Home Based ◽

To Receive

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.

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TRENDS AND FACTORS ASSOCIATED WITH PLACE OF DEATH AMONG INDIVIDUALS WITH CARDIOVASCULAR DISEASE IN THE UNITED STATES

Innovation in Aging ◽

10.1093/geroni/igz038.482 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S132-S133 ◽

Cited By ~ 1

Author(s):

Sarah H Cross ◽

Brystana G Kaufman ◽

Haider Warraich

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Heart Disease ◽

College Education ◽

Hypertensive Heart Disease ◽

The United States ◽

Place Of Death ◽

Home Death ◽

Factors Associated ◽

At Home

Abstract While most patients prefer to die at home, trends and factors associated with place of death for patients dying of cardiovascular disease (CVD) remain unknown. Using data from the National Center for Health Statistics from 2003-2017, we described trends and conducted multivariable logistic regression to evaluate associations between demographic characteristics and place of death among CVD patients in the United States. From 2003-2017, the rate of CVD deaths occurring at home increased from 21.3% to 30.9%, and rate of hospice facility deaths increased from practically none to 6.0%. Over the same period, the rate of hospital deaths decreased from 36.5% to 27.3%, and nursing facility deaths decreased from 25.1% to 20.6%. With the exception of conduction disorders, temporal trends in place of death were consistent across CVD diagnosis subgroups: ischemic heart disease, hypertensive heart disease, heart failure/cardiomyopathy, cerebrovascular disease, aortic stenosis, and all other CVDs. Differences between demographic groups persisted over the study period, with reduced odds of home death among Hispanic versus non-Hispanic (OR=.942; 95% CI .929-.955) decedents, Black versus White (OR=.837; CI .809-.866) decedents and greater odds of home death among decedents with some college education or more (OR=1.08; CI 1.06-1.09) versus decedents with a high-school education or less. In 2014, home surpassed hospital as the most common place of death for CVD patients. CVD patients often have acute and intense needs at the end of life that are challenging to manage in the home and the quality of care these patients receive should be further investigated.

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Symptom Prevalence and Place of Death Preference in Advanced Cancer Patients: Factors Associated With the Achievement of Home Death

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211048767 ◽

2021 ◽

pp. 104990912110487

Author(s):

Julia Fee Voon Ho ◽

Nur Syafiqah Marzuki ◽

Nur Syuhadah Monica Meseng ◽

Viknaswary Kaneisan ◽

Yin Khek Lum ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Symptom Burden ◽

Place Of Death ◽

Hospital Death ◽

Advanced Cancer Patients ◽

Home Death ◽

Factors Associated ◽

Symptom Prevalence

Objectives: Achievement of patients’ preferred place of death is recognized as a component of a good death. This study aimed to investigate the symptom burden in advanced cancer patients, achievement of their place of death preferences and factors associated with home death. Methods: In this retrospective review of 287 patient deaths, we examined patients’ symptom prevalence, preferred and actual place of death and achievement of their place of death preferences using descriptive statistics. Associations between patient factors, home death preference and actual home death were further analyzed using multivariate logistic regression. Results: The most prevalent symptoms were weakness, pain and poor appetite, with a mean of 5.77(SD: 2.37) symptoms per patient. The median interval from palliative care referral to death was 21 (IQR: 74) days. Of the 253 patients with documented place of death preference, 132 (52.1%) preferred home death, 111(43.9%) preferred hospital death, 1 (0.4%) preferred to die at a temple and 9(3.6%) expressed no preference. Overall, 221 of 241(91.7%) patients with known actual place of death achieved their preference. Older patients were more likely to prefer home death (OR 1.021; 95% CI 1.004-1.039, p = 0.018) and die at home (OR 1.023; 95% CI 1.005-1.041, p = 0.014). Gender, marital status, cancer diagnosis and symptoms were not associated with preference for or actual home death. Conclusion: Despite a high symptom burden, most patients preferred and achieved a home death. Late palliative care referral and difficult symptom management contributed to failure to fulfill home death preference. Preference for home death should be considered when managing terminally ill geriatric patients.

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Factors associated with 30-day readmission after hospitalisation for community-acquired pneumonia in older patients: a cross-sectional study in seven Spanish regions

BMJ Open ◽

10.1136/bmjopen-2017-020243 ◽

2018 ◽

Vol 8 (3) ◽

pp. e020243 ◽

Cited By ~ 5

Author(s):

Diana Toledo ◽

Núria Soldevila ◽

Núria Torner ◽

María José Pérez-Lozano ◽

Elena Espejo ◽

...

Keyword(s):

Hospital Readmission ◽

The Elderly ◽

Cross Sectional Study ◽

Community Acquired Pneumonia ◽

Home Healthcare ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Spanish Regions ◽

Hospital Visits

ObjectiveHospital readmission in patients admitted for community-acquired pneumonia (CAP) is frequent in the elderly and patients with multiple comorbidities, resulting in a clinical and economic burden. The aim of this study was to determine factors associated with 30-day readmission in patients with CAP.DesignA cross-sectional study.SettingThe study was conducted in patients admitted to 20 hospitals in seven Spanish regions during two influenza seasons (2013–2014 and 2014–2015).ParticipantsWe included patients aged ≥65 years admitted through the emergency department with a diagnosis compatible with CAP. Patients who died during the initial hospitalisation and those hospitalised more than 30 days were excluded. Finally, 1756 CAP cases were included and of these, 200 (11.39%) were readmitted.Main outcome measures30-day readmission.ResultsFactors associated with 30-day readmission were living with a person aged <15 years (adjusted OR (aOR) 2.10, 95% CI 1.01 to 4.41), >3 hospital visits during the 90 previous days (aOR 1.53, 95% CI 1.01 to 2.34), chronic respiratory failure (aOR 1.74, 95% CI 1.24 to 2.45), heart failure (aOR 1.69, 95% CI 1.21 to 2.35), chronic liver disease (aOR 2.27, 95% CI 1.20 to 4.31) and discharge to home with home healthcare (aOR 5.61, 95% CI 1.70 to 18.50). No associations were found with pneumococcal or seasonal influenza vaccination in any of the three previous seasons.ConclusionsThis study shows that 11.39% of patients aged ≥65 years initially hospitalised for CAP were readmitted within 30 days after discharge. Rehospitalisation was associated with preventable and non-preventable factors.

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Insights into the factors associated with achieving the preference of home death in terminal cancer: A national population-based study

Palliative & Supportive Care ◽

10.1017/s1478951517000876 ◽

2017 ◽

Vol 16 (6) ◽

pp. 749-755 ◽

Cited By ~ 6

Author(s):

Finian Bannon ◽

Victoria Cairnduff ◽

Deirdre Fitzpatrick ◽

Janine Blaney ◽

Barbara Gomes ◽

...

Keyword(s):

Cancer Patients ◽

Population Based ◽

Postal Questionnaire ◽

Place Of Death ◽

Home Death ◽

District Nurse ◽

Terminally Ill Cancer Patients ◽

Factors Associated ◽

Dying At Home ◽

At Home

ABSTRACTObjectives:Most terminally ill cancer patients prefer to die at home, yet only a minority are able to achieve this. Our aim was to investigate the factors associated with cancer patients achieving their preference to die at home.Methods:This study took the form of a mortality followback, population-based, observational survey of the relatives of deceased cancer patients in Northern Ireland. Individuals who registered the death of a friend or relative (aged ≥ 18 years) between 1 December 2011 and 31 May 2012, where the primary cause of death was cancer (ICD10: C00–D48), who were invited to take part. Preferred and actual place of death, and patient, service, and clinical data were collected using the QUALYCARE postal questionnaire. Multivariable logistic regression was employed to investigate the factors associated with achieving a home death when preferred.Results:Some 467 of 1,493 invited informants completed the survey. The 362 (77.5%) who expressed a preference for dying at home and spent time at home in their final 3 months were included in our analysis. Of these, 53.4% achieved their preference of a home death. Factors positively associated with achieving a home death were: living in an affluent area, receipt of good and satisfactory district nurse care, discussing place of death with health professionals, and the caregiver's preference for a home death. Being older than 80 years of age, being a Presbyterian, and being unconscious most of the time during their final week were negatively associated with achieving a home death.Significance of Results:Communication, care satisfaction, and caregiver preferences were all associated with home death. Our findings will help inform the design of future interventions aimed at increasing the proportion of patients achieving their preferred place of death at home, for example, by targeting interventions toward older patients and those from the most deprived communities.

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Preference for death at home and associated factors among older people in the city of Belo Horizonte, Brazil

Ciência & Saúde Coletiva ◽

10.1590/1413-81232018248.24102017 ◽

2019 ◽

Vol 24 (8) ◽

pp. 3001-3012 ◽

Cited By ~ 3

Author(s):

Rafaela Jorge ◽

Natália Calanzani ◽

Adelaide Freitas ◽

Rui Nunes ◽

Liliana Sousa

Keyword(s):

Older People ◽

Associated Factors ◽

Good Health ◽

Place Of Death ◽

Home Death ◽

Factors Associated ◽

Binomial Regression ◽

Belo Horizonte ◽

The City ◽

At Home

Abstract We examined people’s preferences for place of death and identified factors associated with a home death preference. We asked a representative sample (N = 400) of older people (≥ 60 years) residents in the city of Belo Horizonte, about their preferences for place of death in a situation of serious illness with less than a year to live. Data were analyzed using binomial regression to identify associated factors. 52.2% indicate home as the preferred place of death. Five variables were associated with preference for death at home: those living with 1 child (odds ratio (OR)0.41; 95% confidence interval (CI):0.18-0.92; ref: without children); being in education for up to 4 years (OR0.42; 95% CI:0.20-0.89; ref: higher education); finding it difficult to live with the present income (OR3.18; 95% CI:1.53-6.62; ref: living comfortably); self-assessed fair overall health (OR2.07; 95% CI:1.06-4.03; ref: very good health) and selecting “choosing who makes decisions about your care” as the care priority that would matter to them the most (OR2.43; 95%CI:1.34-4.40; ref: dying in the place you want). Most respondents chose home as preferred place of death. However, most residents of Belo Horizonte die in hospitals, suggesting that preferences are not being considered.

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