Place-of-death preferences among patients with cancer and family caregivers in inpatient and outpatient palliative care

Abstract

ObjectiveMeeting the preferences of patients is considered an important palliative care outcome. Prior studies reported that more than 80% of patients with terminally ill cancer prefer to die at home. The purpose of this study was to determine place-of-death preference among palliative care patients in the outpatient centre and the palliative care unit (PCU) of a comprehensive cancer centre.MethodsA cross-sectional anonymous questionnaire was administered to patients with advanced cancer and caregivers (PCU and outpatient centre) between August 2012 and September 2014. PCU patients responded when there was no delirium and the primary caregiver responded when the patient was unable to respond. In the case of outpatients, dyads were assessed. The survey was repeated 1 month later.ResultsOverall, 65% preferred home death. There was less preference for home death among PCU patients (58%) than among outpatients (72%). Patient and caregiver agreement regarding preferred place of death for home was 86%. After 1 month, outpatients were significantly more likely than PCU patients to have the same preferred place of death as they had 1 month earlier (96% vs 83%; p=0.003).ConclusionsAlthough home was the preferred place of death in our group of patients with advanced cancer and their caregivers, a substantial minority preferred hospital death or had no preference. We speculate that PCU patients’ higher preference for hospital death is likely related to more severe distress because they had already tried home care. Personalised assessment of place of death preference for both patient and caregiver is needed.

Aggressiveness of care at end of life in patients with high‐grade glioma

“…A small minority of patients with HGG were referred for PC at our institution, limiting the overall patient numbers in this study, and also introducing the possibility of selection bias. We also feel it is important to highlight that death in the hospital, one of the metrics used to characterize overly aggressive EoL care, may be beneficial to select patients with high levels of distress, 34 highlighting the limitation of applying this quality metric to all patients. Despite these limitations, this study provides novel insight into the EoL period in patients with HGG and identifies various demographic, disease‐related, and clinical variables that can influence EoL care in this population.…”

Preferred Place of Death in Adult Cancer Patients: A Systematic Review and Meta-Analysis

“…Of these, approximately 1.6 million patients did not die in their preferred place (Kern et al, 2020). Patients with advanced cancer show that despite the fact that the majority of cancer patients prefer to die in the preferred place (Neergaard et al, 2011;Hyun et al, 2013;Gomes et al, 2015;Vidal et al, 2020), a small number of these patients die in the preferred place (Chen et al, 2014;Howell et al, 2017).…”

Pasienters opplevelse av trygghet med palliativ omsorg i hjemmet

“…Pasienter i sen palliativ fase ønsker ofte å vaere hjemme så lenge det lar seg gjøre og leve et liv så naert opp til det vante som mulig (Bannon et al, 2018;Fringer et al, 2018;Higginson et al, 2014;Jonasson et al, 2019;Sandsdalen et al, 2015a). Mange pasienter ønsker også å få dø hjemme (Gomes et al, 2013;Vidal et al, 2020). Dette er i tråd med norske helsemyndigheters intensjoner (Meld.…”

“…St. 24 (2019). Å imøtekomme pasientenes preferanser er et viktig resultat i palliativ omsorg (Vidal et al, 2020) og et mål på kvalitet (World Health Organization (WHO, 2006)). En side ved kvalitet er pasienters opplevelse av trygghet med den palliative omsorgen (Shafir et al, 2016).…”