scholarly journals Where Do Cancer Patients in Receipt of Home-Based Palliative Care Prefer to Die and What Are the Determinants of a Preference for a Home Death?

2020 ◽  
Vol 18 (1) ◽  
pp. 235
Author(s):  
Jiaoli Cai ◽  
Li Zhang ◽  
Denise Guerriere ◽  
Hongli Fan ◽  
Peter C. Coyte
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Health Care Services ◽  
Multivariate Regression Analysis ◽  
Place Of Death ◽  
Support Worker ◽  
Home Death ◽  
Physician Visits ◽  
Personal Support ◽  
Home Based

Understanding the preferred place of death may assist to organize and deliver palliative health care services. The study aims to assess preference for place of death among cancer patients in receipt of home-based palliative care, and to determine the variables that affect their preference for a home death. A prospective cohort design was carried out from July 2010 to August 2012. Over the course of their palliative care trajectory, a total of 303 family caregivers of cancer patients were interviewed. Multivariate regression analysis was employed to assess the determinants of a preferred home death. The majority (65%) of patients had a preference of home death. The intensity of home-based physician visits and home-based personal support worker (PSW) care promotes a preference for a home death. Married patients, patients receiving post-graduate education and patients with higher Palliative Performance Scale (PPS) scores were more likely to have a preference of home death. Patients reduced the likelihood of preferring a home death when their family caregiver had high burden. This study suggests that the majority of cancer patients have a preference of home death. Health mangers and policy makers have the potential to develop policies that facilitate those preferences.

What Variables Contribute to the Achievement of a Preferred Home Death for Cancer Patients in Receipt of Home-Based Palliative Care in Canada?

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jiaoli Cai ◽  
Li Zhang ◽  
Denise Guerriere ◽  
Hongli Fan ◽  
Peter C. Coyte
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Home Death ◽  
Home Based

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

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.

scholarly journals What Determines the Final Place of Care of Advanced Cancer Patients Receiving Integrated Home-based Palliative Care?: a Retrospective Cohort Study

2021 ◽  
Author(s):  
RiYin Tay ◽  
Rozenne WK Choo ◽  
WahYing Ong ◽  
Allyn YM Hum
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Cancer Patients ◽  
Family Caregivers ◽  
Advanced Cancer ◽  
Terminal Care ◽  
Retrospective Cohort ◽  
Advanced Cancer Patients ◽  
Home Death ◽  
Home Based

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.

Exploring the preferences for place of death among cancer patients and their family caregivers.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 40-40 ◽  
Author(s):  
Marieberta Vidal
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Place Of Death ◽  
Hospital Death ◽  
Advanced Cancer Patients ◽  
Home Death ◽  
Significant Difference ◽  
The Uk ◽  
At Home

40 Background: Understanding the preferred place of death (POD) for advanced cancer patients (Pts) is very important when they are approaching the end of life. Meeting the preferences of Pts is considered an important palliative care (PC) outcome. Prior studies reported that more than 80% of Pts with terminally ill cancer prefer to die at home. In many countries such as the UK, Italy, Greece, South Korea and Japan home deaths have been falling, but in some states of the US and Canada there are indications of a reversal of trends. Dying at home may be more difficult for Pts in severe physical and psychosocial distress, or when there are social or financial difficulties. The purpose of this study was to determine POD preference among PC Pts in the outpatient center (OC) and the palliative care unit (PCU). Methods: A sectional anonymous questionnaire was administered to advanced cancer Pts and caregivers (PCU patients and OC) between August 2012 and September 2014. PCU Pts responded when there was no delirium and the primary caregiver responded when the patient was unable to respond. In the case of outpatients dyads (patient and caregiver) were assessed. Results: Overall 141/216 (65%) preferred home death. PCU patients preferred home death less than outpatients. Patient and caregiver agreement regarding preferred place of death was 86% (p <0.001). The preferred POD was the same as one month ago for 82/99 (83%) PCU Pts and 111/116 (96%) outpatients, with significant difference between groups (p=0.002). Conclusions: Although home is the preferred POD in advanced cancer Pts, a substantial minority prefer hospital death or no difference. Patients admitted to the PCU have a higher preference for hospital death in comparison to the outpatients, likely reflecting more severe distress because they already tried home care. Pts and caregivers agree on POD in most cases. Personalized assessment of POD preference for both patient and caregiver is needed. [Table: see text]

The Impact of Socioeconomic Status on Place of Death Among Patients Receiving Home Palliative Care in Toronto, Canada: A Retrospective Cohort Study

2019 ◽  
Vol 35 (3) ◽  
pp. 167-173
Author(s):  
Joshua Wales ◽  
Sumeet Kalia ◽  
Rahim Moineddin ◽  
Amna Husain
Keyword(s):  
Socioeconomic Status ◽  
Palliative Care ◽  
Acute Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Place Of Death ◽  
Income Quintile ◽  
Home Death ◽  
Home Based ◽  
The Impact

Background: Socioeconomic disparities in home death have been noted in the literature. Home-based palliative care increases access to home death and has been suggested as a means to decrease these disparities. Aim: Our study examines the association between socioeconomic status and other demographic factors on place of death in a population receiving home palliative care in Toronto, Canada. Design: This is a retrospective chart review of patients who died between August 2013 and August 2015 when admitted to a home-based palliative care service. Multivariate multinomial regression examined the relationship between the place of death (home, palliative care unit [PCU], or acute care) with age, gender, primary diagnosis, and income quintile. Bivariate logistic regression was fitted to calculate the odds ratio (OR) and probability of preference for home death. Setting/Participants: Patients receiving home-based palliative care services from the Latner Centre for Palliative Care in Toronto, Canada. Results: A total of 2066 patients were included in multivariate analysis. Patients in the lowest income quintile had increased odds of dying in acute care (OR = 2.41, P < .001) or dying in PCU (OR = 1.64, P = .008) than patients in highest income quintile. Patients in the next lowest income quintiles 2 and 3 were also more likely to die in acute care. The rate of preference for home death was significantly lower in the lowest income quintile (OR = 0.47, P = .0047). Conclusions: Patients in lower income quintiles are less likely to die at home, despite receiving home-based palliative care, although they may also be less likely to prefer home death.

The determinants of the intensity of home-based informal care among cancer patients in receipt of home-based palliative care

2020 ◽  
pp. 026921632097927
Author(s):  
Jiaoli Cai ◽  
Li Zhang ◽  
Denise Guerriere ◽  
Peter C Coyte
Keyword(s):  
Palliative Care ◽  
Marital Status ◽  
Cancer Patients ◽  
Informal Care ◽  
Instrumental Variables ◽  
Spousal Caregivers ◽  
Living Alone ◽  
Policy Makers ◽  
Cohort Design ◽  
Home Based

Background: Understanding the determinants of the intensity of informal care may assist policy makers in the identification of supports for informal caregivers. Little is known about the utilization of informal care throughout the palliative care trajectory. Aim: The purpose of this study was to analyze the intensity and determinants of the use of informal care among cancer patients over the palliative care trajectory. Design: This was a longitudinal, prospective cohort design conducted in Canada. Regression analysis using instrumental variables was applied. Setting/participants: From November 2013 to August 2017, a total of 273 caregivers of cancer patients were interviewed biweekly over the course of the care recipient’s palliative care trajectory. The outcome was the number of hours of informal care provided by unpaid caregivers, that is, hours of informal care. Results: The number of hours of informal care increased as patients approached death. Home-based nursing care complemented, and hence, increased the provision of informal care. Patients living alone and caregivers who were employed were associated with the provision of fewer hours of informal care. Spousal caregivers provided more hours of informal care. Patient’s age, sex, and marital status, and caregiver’s age, sex, marital status, and education were associated with the number of hours of informal care. Conclusions: The intensity of informal care was determined by predisposing, enabling, and needs-based factors. This study provides a reference for the planning and targeting of supports for the provision of informal care.

scholarly journals Predicting Place of Death of Elderly Cancer Patients Followed by a Palliative Care Unit

2001 ◽  
Vol 21 (6) ◽  
pp. 481-490 ◽  
Author(s):  
Anna Maria Izquierdo-Porrera ◽  
Jordi Trelis-Navarro ◽  
Xavier Gómez-Batiste
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Palliative Care Unit ◽  
Place Of Death ◽  
Elderly Cancer Patients

Determinants of place of Death for recipients of Home-Based Palliative Care

2010 ◽  
Vol 26 (4) ◽  
pp. 279-286 ◽  
Author(s):  
Lisa Masucci ◽  
Denise N. Guerriere ◽  
Richard Cheng ◽  
Peter C. Coyte
Keyword(s):  
Palliative Care ◽  
Place Of Death ◽  
Home Based

Factors that Promote Success in Home Palliative Care: A Study of a Large Suburban Palliative Care Practice

2002 ◽  
Vol 18 (4) ◽  
pp. 282-286 ◽  
Author(s):  
Vincent Maida
Keyword(s):  
Palliative Care ◽  
Home Ownership ◽  
Care Service ◽  
Palliative Care Service ◽  
Care Physician ◽  
Care Practice ◽  
Evaluation Tool ◽  
Home Death ◽  
Home Based ◽  
At Home

It has been repeatedly shown that most people would prefer to die in their own homes. However, many factors affect the feasibility of this choice. This study retrospectively examined the medical and nursing charts of 402 cancer patients who wished to die at home and had been referred to a palliative care service. Of those reviewed, 223 (55%) died at home, while 179 died in hospitals. The presence of more than one caregiver, an increased length of time between diagnosis and referral to a palliative care physician, an increased length of time under that physician's care, older age at referral, home ownership, and race were all significantly associated with home death, as were certain cancer diagnoses. The most compelling of these predictive factors have formed the basis for an evaluation tool, soon to be validated, to help palliative health professionals assess the viability of home-based palliative care culminating in a home death.

Sign in / Sign up

Export Citation Format

Share Document