Predictors of Home Death in Palliative Care Cancer Patients

Abstract

With recent changes in health care there is greater emphasis on providing care at home, including the support of families to enable more home deaths. Since a home death may not be practical or desirable in every family situation, there is a need for an objective way to assess the viability of a home death in each individual family situation. The purpose of this study was to describe the relative role of predictors of home death in a cohort of palliative care patients with advanced cancer. A questionnaire was created as a means of assessing the viability of a home death. Five questions were included. Ninety questionnaires were administered by home care coordinators. A follow-up questionnaire was administered to record the place of death. Of the 73 evaluable patients, 34 (47%) died at home and 39 (53%) died in hospital or hospice. The desire for a home death by both the patient and the caregiver, support of a family physician, and presence of more than one caregiver were all significantly associated with a home death. Logistic regression identified a desire for home death by both the patient and the caregiver as the main predictive factor for a home death. The presence of more than one caregiver was also predictive of home death. The questionnaire is simple and, if our results are confirmed, it can be used for predicting those who will not have a home death.

Factors influencing preferences for place of terminal care and of death among cancer patients and their families in Korea

“…More research needs to focus on the extent to which family members' views differ from the patients' views. Also, prospective studies are needed to test hypotheses about predictors of preferences as to place of death and actual place of death [29], and identification of outcomes if preferences are achieved. It would be helpful for palliative care professionals to know the effects of a divergence of opinion on the decision of place of death as well as the process families go through to achieve consensus.…”

Predictive factors for home deaths among cancer patients in Swedish palliative home care

“…The patient's preference for dying at home is shown to be significantly associated with home death [4,16,18]. Other identified factors facilitating home death are: family support [7,10], caregiver preference [5], multiple caregivers [18], provision of specialised palliative home care [6], regular home visits by a physician [4] and access to a palliative consultant team [15]. Factors hampering home care and home death are: a short interval from diagnosis to death [2], living alone [14], older age [9,10,11] and a long period of palliative care [14].…”

Soins spécifiques et soins de support en cancérologie à domicile: expérience du centre Léon-Bérard sur 751 patients en 2003

“…Lorsque les patients expriment une pré fé rence, ils se prononcent majoritairement pour un dé cè s à domicile alors que la majorité des dé cè s surviennent à l'hô pital [13,26]. Le taux de dé cè s à domicile est assez voisin dans les diffé rents pays occidentaux et proches de celui retrouvé dans notre é tude [1,9,19,23,29]. Ce taux varie de 29 % dans une é tude amé ricaine [19] à 47 % dans une é tude canadienne [9] contre 36 % dans notre é tude.…”

“…Le taux de dé cè s à domicile est assez voisin dans les diffé rents pays occidentaux et proches de celui retrouvé dans notre é tude [1,9,19,23,29]. Ce taux varie de 29 % dans une é tude amé ricaine [19] à 47 % dans une é tude canadienne [9] contre 36 % dans notre é tude. Plusieurs facteurs ont é té associé s à un taux de dé cè s à domicile é levé mais ils sont variables et parfois contradictoires d'une é tude à l'autre.…”

“…Parmi les caracté ristiques gé né rales des patients, certaines é tudes retiennent comme facteur statistiquement associé à un dé cè s à domicile le sexe fé minin [8,19], d'autres le sexe masculin [1,25,29], l'â ge avancé [8,34] ou au contraire un jeune â ge [4], un domicile rural [13] ou au contraire urbain [8], ou encore un type caucasien [6,7,19,34]. De maniè re plus inté ressante, le nombre de visites à domicile du mé decin traitant ou des infirmiè res semble corré lé audé cè s à domicile [8,18,26] de mê me que l'existence d'un programme de coordination [9,14,[18][19][20]23], mê me si certains auteurs ne confirment pas cette hypothè se [20,23,28]. Dans notre expé rience, qui n'est pas celle d'une é quipe mobile de soins palliatifs mais d'une structure de coordination en oncologie gé né rale, le MOC apparaît comme un é lé ment clé du dispositif, vé ritable pont entre l'oncologue et les soignants du domicile, permettant à chacun de trouver sa place spé cifique tout en contribuant tous ensembles au succè s du projet de soins à domicile [12].…”