Factors Affecting the Place of Death Among Hospice Home Care Cancer Patients in Taiwan

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.

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

BMC Palliative Care ◽

10.1186/s12904-020-00664-4 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Heidi Kern ◽

Giorgio Corani ◽

David Huber ◽

Nicola Vermes ◽

Marco Zaffalon ◽

...

Keyword(s):

Home Care ◽

End Of Life ◽

Cancer Patients ◽

Expert Knowledge ◽

Place Of Death ◽

Data Mining Algorithm ◽

Open Communication ◽

Data Set ◽

Palliative Home Care ◽

At Home

Abstract Background Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care. Methods A data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review. Results Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family’s preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient’s preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%. Conclusion Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family’s decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.

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Factors affecting place of death of hospice and non-hospice cancer patients.

American Journal of Public Health ◽

10.2105/ajph.79.11.1549 ◽

1989 ◽

Vol 79 (11) ◽

pp. 1549-1551 ◽

Cited By ~ 64

Author(s):

C M Moinpour ◽

L Polissar

Keyword(s):

Cancer Patients ◽

Place Of Death ◽

Factors Affecting

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

10.21203/rs.3.rs-29758/v1 ◽

2020 ◽

Author(s):

Heidi Kern ◽

Giorgio Corani ◽

David Huber ◽

Nicola Vermes ◽

Marco Zaffalon ◽

...

Keyword(s):

Home Care ◽

End Of Life ◽

Cancer Patients ◽

Family Caregivers ◽

Patient Preference ◽

End Of Life Care ◽

Place Of Death ◽

Life Care ◽

Palliative Home Care ◽

At Home

Abstract Background Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care. Methods A data mining algorithm (a classifier) and a causal probabilistic model (a credal network) for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review. Results Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family’s preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient’s preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%. Conclusion Concerning death at home, open communication about dying is essential. Furthermore, for the patient preference for home care to be respected, the family’s decision for the last place of care seems key. Early initiation of family-centred palliative care and provision of specialist palliative home care for patients who wish to die at home are suggested. Keywords Cancer; End-of-life care; Palliative Home care; Place of death; Communication; Family caregivers; Patient preference; Bayesian networks; Credal networks; Bayesian classifiers

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

10.21203/rs.3.rs-29758/v2 ◽

2020 ◽

Author(s):

Heidi Kern ◽

Giorgio Corani ◽

David Huber ◽

Nicola Vermes ◽

Marco Zaffalon ◽

...

Keyword(s):

Home Care ◽

End Of Life ◽

Cancer Patients ◽

Expert Knowledge ◽

Place Of Death ◽

Data Mining Algorithm ◽

Open Communication ◽

Data Set ◽

Palliative Home Care ◽

At Home

Abstract Background Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care.Methods A data mining algorithm (a classifier) and a causal probabilistic model (a credal network) for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review.Results Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family’s preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient’s preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%.Conclusion Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family’s decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.

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Impact of Home Care on Place of Death, Access to Emergency Departments and Opioid Therapy in 350 Terminal Cancer Patients

Tumori Journal ◽

10.1177/030089160809400117 ◽

2008 ◽

Vol 94 (1) ◽

pp. 87-95 ◽

Cited By ~ 8

Author(s):

Mario Saugo ◽

Michele Pellizzari ◽

Laura Marcon ◽

Pierpaolo Benetollo ◽

Roberto Toffanin ◽

...

Keyword(s):

Home Care ◽

Cancer Patients ◽

Emergency Departments ◽

Opioid Therapy ◽

Place Of Death ◽

Terminal Cancer ◽

Terminal Cancer Patients

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Effect of home care on the place of death of advanced cancer patients

European Journal of Cancer ◽

10.1016/0959-8049(96)00036-6 ◽

1996 ◽

Vol 32 (7) ◽

pp. 1142-1147 ◽

Cited By ~ 81

Author(s):

F. De Conno ◽

A. Caraceni ◽

L. Groff ◽

C. Brunelli ◽

I. Donati ◽

...

Keyword(s):

Home Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Place Of Death ◽

Advanced Cancer Patients

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

10.21203/rs.3.rs-29758/v3 ◽

2020 ◽

Author(s):

Heidi Kern ◽

Giorgio Corani ◽

David Huber ◽

Nicola Vermes ◽

Marco Zaffalon ◽

...

Keyword(s):

Home Care ◽

End Of Life ◽

Cancer Patients ◽

Expert Knowledge ◽

Place Of Death ◽

Data Mining Algorithm ◽

Open Communication ◽

Data Set ◽

Palliative Home Care ◽

At Home

Abstract BackgroundMost terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care.MethodsA data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review.ResultsDependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family’s preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient’s preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%.ConclusionConcerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family’s decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.

Download Full-text