Preferred place of death and end-of-life care for adult cancer patients in Iran: A cross-sectional study

Abstract

BackgroundMore than 50,000 deaths in terms of cancer occur annually in Iranian hospitals. Determining the preferred place of end-of-life care and death for cancer patients in Iran is a quality marker for good end-of-life care and good death. The purpose of this study was to determine the preferred place of end-of-life care and death in cancer patients.MethodIn 2021, the current descriptive cross-sectional investigation was carried out. Using the convenience sample approach, patients were chosen from three Tehran referral hospitals (the capital of Iran). A researcher-made questionnaire with three parts for demographic data, clinical features, and two questions on the choice of the desired location for end-of-life care and the death of cancer patients served as the data collecting instrument. Data were analyzed using SPSS software version 18. The relationship between the two variables preferred place for end-of-life care and death and other variables was investigated using chi-square, Fisher exact test, and multiple logistic regression.ResultThe mean age of patients participating in the study was 50.21 ± 13.91. Three hundred ninety (69.6%) of the patients chose home, and 170 (30.4%) patients chose the hospital as the preferred place of end-of-life care. Choosing the home as a preferred place for end-of-life care had a significant relationship with type of care (OR = .613 [95% CI: 0.383–0.982], P = .042), level of education (OR = 2.61 [95% CI: 1.29–5.24], P = 0.007), type of cancer (OR = 1.70 [1.01–2.89], P = .049), and income level (Mediate: (OR: 3.27 (1.49, 7.14), P = .003) and Low: (OR: 3.38 (1.52–7.52), P = .003). Also, 415 (75.2%) patients chose home and 137 (24.8%) patients chose hospital as their preferred place of death. Choosing the home as a preferred place of death had a significant relationship with marriage (OR = 1.62 [95% CI: 1.02–2.57], P = .039) and time to diagnostic disease less than 6 months (OR = 1.62 [95% CI: 0.265–0.765], P = .002).ConclusionThe findings of the current research indicate that the majority of cancer patients selected their homes as the preferred location for end-of-life care and final disposition. Researchers advise paying more attention to patients’ wishes near the end of life in light of the findings of the current study. This will be achieved by strengthening the home care system using creating appropriate infrastructure, insurance coverage, designing executive instructions, and integration of palliative care in home care services.

Predicting Place of Death of Patients with Advanced Cancer Receiving Home-Based Palliative Care Services in Iran

“…A recent study by Fereidouni et al reported that over 75% of a group of Iranian advanced cancer patients preferred to die at home [25]. The concordance between the patient's preferred PoD and the actual PoD is an important indicator of the effectiveness of palliative care services [41], though, we did not include patients' preferences in our study.…”

“…Access to palliative care in Iran is limited to the services provided by the "Iranian Cancer Control Center" (aka MACSA, formerly "Ala Cancer Control Center"), the largest provider of palliative care services in Iran, and a few hospital-based palliative care programs [24]. However, a study performed in 2022 in Iran indicated that 75% of patients with advanced cancer preferred to stay at home at the end of their lives [25]. Iranian caregivers and nurses also agree that patients' death at home is preferred over other places [26].…”

The impact of an integrated early palliative care telehealth intervention on the quality of life of heart failure patients: a randomized controlled feasibility study

“…In this study, certain patients in the intervention group declined to express their thoughts and preferences regarding death and decision-making. This reluctance may be attributed to cultural factors, as there is a prevailing belief in Iranian culture that discussing death and dying with patients is unsuitable due to the potential for causing stress and anxiety and negatively affecting patient morale [56]. This aspect is evident in studies conducted to assess death anxiety among Iranian cardiovascular patients as well [57][58][59].…”

Psychometric properties of Persian version of advance care planning questionnaire among older adults in Iran

“…In Iran, attention to end-of-life issues and problems can be enhanced through an approach called palliative care [ 10 ]. The study by Fereidouni et al in Iran indicated that in order to support patients, care providers and families of patients, the place where palliative care is provided for patients at the end-of-life should be compatible with their wishes and preferences [ 11 ]. Furthermore, elderly patients at the end-of-life should share their preferences with others around them, or choose a person as a proxy decision-maker [ 12 ].…”

“…In one study found that Muslim people put off uncomfortable conversations about care planning until they become ill or suddenly become unable to express their wishes [ 18 ]. Despite the interesting of Muslim community in learning and receiving the concept of ACP [ 19 ], ACP in Iran, does not exist in a coherent way, but researchers and clinician have separately and limitedly investigated the dimensions of it, including palliative care [ 10 , 20 ] and hospice care [ 15 , 21 ], preferred place of care and preferred place of death [ 11 ], have a kind of ADs as Vasiyyah [ 22 ], and do not resuscitation [ 23 ] in their practice and research [ 24 ].…”