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

Saugo, Mario; Pellizzari, Michele; Marcon, Laura; Benetollo, P.; Toffanin, Roberto; Gallina, Pietro; Cecchetto, Giovanna; Miccinesi, Guido; Rigon, Stefano; Cancian, Maurizio; Sichetti, Daniela

doi:10.1177/030089160809400117

Cited by 9 publications

(26 citation statements)

References 28 publications

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“…These effects are consistent with the existing literature: receiving chemotherapy in the last month of life has been associated with a reduced likelihood of a home death [11]; the provision of palliative care by the GP has been associated with an increased likelihood of home death [5], [19], [30], [53]–[57]; dying in the preferred place of death has been associated with GP involvement and GP home visits [32], [35]. The exact role of the GP in the provision of health care in general and more specifically in the provision of palliative care differs between countries.…”

Section: Discussionsupporting

confidence: 88%

Actual and Preferred Place of Death of Home-Dwelling Patients in Four European Countries: Making Sense of Quality Indicators

et al. 2014

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BackgroundDying at home and dying at the preferred place of death are advocated to be desirable outcomes of palliative care. More insight is needed in their usefulness as quality indicators. Our objective is to describe whether “the percentage of patients dying at home” and “the percentage of patients who died in their place of preference” are feasible and informative quality indicators.Methods and FindingsA mortality follow-back study was conducted, based on data recorded by representative GP networks regarding home-dwelling patients who died non-suddenly in Belgium (n = 1036), the Netherlands (n = 512), Italy (n = 1639) or Spain (n = 565). “The percentage of patients dying at home” ranged between 35.3% (Belgium) and 50.6% (the Netherlands) in the four countries, while “the percentage of patients dying at their preferred place of death” ranged between 67.8% (Italy) and 86.0% (Spain). Both indicators were strongly associated with palliative care provision by the GP (odds ratios of 1.55–13.23 and 2.30–6.63, respectively). The quality indicator concerning the preferred place of death offers a broader view than the indicator concerning home deaths, as it takes into account all preferences met in all locations. However, GPs did not know the preferences for place of death in 39.6% (the Netherlands) to 70.3% (Italy), whereas the actual place of death was known in almost all cases.ConclusionGPs know their patients’ actual place of death, making the percentage of home deaths a feasible indicator for collection by GPs. However, patients’ preferred place of death was often unknown to the GP. We therefore recommend using information from relatives as long as information from GPs on the preferred place of death is lacking. Timely communication about the place where patients want to be cared for at the end of life remains a challenge for GPs.

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Section: Discussionsupporting

confidence: 88%

Actual and Preferred Place of Death of Home-Dwelling Patients in Four European Countries: Making Sense of Quality Indicators

et al. 2014

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“…In the developed world individual’s place of death is a function of both preference and access. Being married in the developed countries is associated with dying at home, this is true because having social support at home facilitates being taken care of at home [29]. However, our result should not be explained in the context of developed countries.…”

Section: Discussionmentioning

confidence: 76%

Factors associated with place of death in Addis Ababa, Ethiopia

2013

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BackgroundDying at home is highly prevalent in Africa partly due to lack of accessibility of modern health services. In turn, limited infrastructure and health care deliveries in Africa complicate access to health services. A weak infrastructure and limited health facilities with lower quality in Ethiopia resulted poor health service utilization and coverage, high morbidity and mortality rates. We examined whether people in Addis Ababa died in health facilities and investigated the basic factors associated with place of death.MethodsWe used verbal autopsy data of 4,776 adults (age>14 years) for the years 2006–2010 from the Addis Ababa Mortality Surveillance Program (AAMSP). The main data source of AAMSP is the burial surveillance from all cemeteries in Addis Ababa. We provide descriptive statistics of place of adult deaths and discussed their covariates using multivariate analyses.ResultsOnly 28.7% died at health facilities, while the remaining died out of health facilities. There was an increase trend in the proportion of health facility deaths from 25.3% in 2006 to 32.5% in 2010. The risk of health facility death versus out of health facility deaths decreased with age. Compared with those who had no education educated people were more likely to die at health facilities. The chance of in health facility death was a little higher for females than males while religion, occupational status and ethnicity of the deceased had no any significance difference in place of death.ConclusionBoth demographic and social factors determine where adults will die in Addis Ababa, Ethiopia. The majority of people in Addis Ababa died out of health facilities. The health system should also give special attention to the emerging non communicable diseases like cancer for effective treatment of patients.

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“…A number of individual studies have examined place of death in patients with haematological malignancies [12-31,48]. Although these report patients dying in hospital more frequently than those with solid tumours, this has never been formally reviewed.…”

Section: Introductionmentioning

confidence: 99%

Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy

et al. 2010

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BackgroundHaematological malignancies are a common, heterogeneous and complex group of diseases that are often associated with poor outcomes despite intensive treatment. Research surrounding end-of-life issues, and particularly place of death, is therefore of paramount importance, yet place of death has not been formally reviewed in these patients.MethodsA systematic literature review and meta-analysis was undertaken using PubMed to identify all studies published between 1966 and 2010. Studies examining place of death in adult haematology patients, using routinely compiled morbidity and mortality data and providing results specific to this disease were included. 21 studies were identified with descriptive and/or risk-estimate data; 17 were included in a meta-analysis.ResultsCompared to other cancer deaths, haematology patients were more than twice as likely to die in hospital (Odds Ratio 2.25 [95% Confidence Intervals, 2.07-2.44]).ConclusionHome is generally considered the preferred place of death but haematology patients usually die in hospital. This has implications for patients who may not be dying where they wish, and also health commissioners who may be funding costly end-of-life care in inappropriate acute hospital settings. More research is needed about preferred place of care for haematology patients, reasons for hospital deaths, and how these can be avoided if home death is preferred.

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

Cited by 9 publications

References 28 publications

Actual and Preferred Place of Death of Home-Dwelling Patients in Four European Countries: Making Sense of Quality Indicators

Actual and Preferred Place of Death of Home-Dwelling Patients in Four European Countries: Making Sense of Quality Indicators

Factors associated with place of death in Addis Ababa, Ethiopia

Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy

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