Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-26T07:15:58.179Z Has data issue: false hasContentIssue false
  • English
  • Français

Insights into the factors associated with achieving the preference of home death in terminal cancer: A national population-based study

Published online by Cambridge University Press:  23 November 2017

Finian Bannon ,
Victoria Cairnduff ,
Deirdre Fitzpatrick ,
Janine Blaney ,
Barbara Gomes ,
Anna Gavin  and
Conan Donnelly
Finian Bannon*
Affiliation:
Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
Victoria Cairnduff
Affiliation:
Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, United Kingdom
Deirdre Fitzpatrick
Affiliation:
Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, United Kingdom
Janine Blaney
Affiliation:
Physiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast, United Kingdom
Barbara Gomes
Affiliation:
Faculty of Medicine, University of Coimbra, Coimbra, Portugal Department of Palliative Care, Policy, and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
Anna Gavin
Affiliation:
Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, United Kingdom
Conan Donnelly
Affiliation:
Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, United Kingdom
*
Address correspondence and reprint requests to: Finian Bannon, Centre for Public Health, Queen's University Belfast, Centre for Public Health, Institute of Clinical Sciences Building, Grosvenor Road, Belfast BT12 6BJ, United Kingdom. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Most terminally ill cancer patients prefer to die at home, yet only a minority are able to achieve this. Our aim was to investigate the factors associated with cancer patients achieving their preference to die at home.

Methods:

This study took the form of a mortality followback, population-based, observational survey of the relatives of deceased cancer patients in Northern Ireland. Individuals who registered the death of a friend or relative (aged ≥ 18 years) between 1 December 2011 and 31 May 2012, where the primary cause of death was cancer (ICD10: C00–D48), who were invited to take part. Preferred and actual place of death, and patient, service, and clinical data were collected using the QUALYCARE postal questionnaire. Multivariable logistic regression was employed to investigate the factors associated with achieving a home death when preferred.

Results:

Some 467 of 1,493 invited informants completed the survey. The 362 (77.5%) who expressed a preference for dying at home and spent time at home in their final 3 months were included in our analysis. Of these, 53.4% achieved their preference of a home death. Factors positively associated with achieving a home death were: living in an affluent area, receipt of good and satisfactory district nurse care, discussing place of death with health professionals, and the caregiver's preference for a home death. Being older than 80 years of age, being a Presbyterian, and being unconscious most of the time during their final week were negatively associated with achieving a home death.

Significance of Results:

Communication, care satisfaction, and caregiver preferences were all associated with home death. Our findings will help inform the design of future interventions aimed at increasing the proportion of patients achieving their preferred place of death at home, for example, by targeting interventions toward older patients and those from the most deprived communities.

Keywords

BereavementCommunicationHome care servicesCancerPalliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 6 , December 2018 , pp. 749 - 755
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Joint first authors.

α

Joint last authors.

References

REFERENCES

Beccaro, M., Costantini, M., Giorgi Rossi, P., et al. (2006). Actual and preferred place of death of cancer patients: Results from the Italian survey of the dying of cancer (ISDOC). Journal of Epidemiology and Community Health, 60(5), 412–416.Google Scholar
Bell, C.L., Somogyi-Zalud, E. & Masaki, K.H. (2010). Factors associated with congruence between preferred and actual place of death. Journal of Pain Symptom Management, 39(3), 591–604.Google Scholar
Blaney, J. & Gavin, A.T. ( 2011). Why Do Cancer Patients Die in Acute Hospitals. Available from http://www.qub.ac.uk/research-centres/nicr.Google Scholar
Brazil, K., Howell, D., Bedard, M., et al. (2005). Preferences for place of care and place of death among informal caregivers of the terminally ill. Palliative Medicine, 19(6), 492–499.Google Scholar
Calanzani, N., Higginson, I.J., Koffman, J., et al. (2016). Factors associated with participation, active refusals and reasons for not taking part in a mortality followback survey evaluating end-of-life care. PLoS One, 11(1), e0146134. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706352/.Google Scholar
Clayton, J., Butow, P., Arnold, R.M., et al. (2005). Discussing end-of-life issues with terminally ill cancer patients and their carers: A qualitative study. Supportive Care in Cancer, 13(9), 733–742.Google Scholar
Cohen, J., Houttekier, D., Onwuteaka-Philipsen, B., et al. (2010). Which patients with cancer die at home? A study of six European countries using death certificate data. Journal of Clinical Oncology, 28(13), 2267–2273.Google Scholar
Compton, P. A., Coward, J. & Wilson-Davis, K. (1985). Family size and religious denomination in Northern Ireland. Journal of Biosocial Science, 17(2), 137–145.Google Scholar
Department of Health (2008). End of Life Care Strategy: Promoting High Quality Care for All Adults at the End of Life. Available from https://www.gov.uk/government/publications/end-of-life-care-strategy-promoting-high-quality-care-for-adults-at-the-end-of-their-life.Google Scholar
Gao, W., Ho, Y.K., Verne, J., et al. (2013). Changing patterns in place of cancer death in England: A population-based study. PLoS Medicine, 10(3), e1001410. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608543/.Google Scholar
Gomes, B. & Higginson, I.J. (2006). Factors influencing death at home in terminally ill patients with cancer: Systematic review. BMJ, 332(7540), 515–521.Google Scholar
Gomes, B., McCrone, P., Hall, S., et al. (2010). Variations in the quality and costs of end-of-life care, preferences and palliative outcomes for cancer patients by place of death: The QUALYCARE study. BMC Cancer, 10, 400. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919503/.Google Scholar
Gomes, B., Calanzani, N., Gysels, M., et al. (2013). Heterogeneity and changes in preferences for dying at home: A systematic review. BMC Palliative Care, 12, 7. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623898/.Google Scholar
Gomes, B., Calanzani, N., Koffman, J., et al. (2015). Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study. BMC Medicine, 13, 235. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599664/.Google Scholar
Hearn, J. & Higginson, I.J. (1999). Development and validation of a core outcome measure for palliative care: The palliative care outcome scale. Palliative Care Core Audit Project Advisory Group. Quality in Health Care, 8(4), 219–227.Google Scholar
Higginson, I. J. & Sen-Gupta, G.J. (2000). Place of care in advanced cancer: A qualitative systematic literature review of patient preferences. Journal of Palliative Medicine, 3(3), 287–300,Google Scholar
Higginson, I.J., Sarmento, V. P., Calanzani, N., et al. (2013). Dying at home—is it better: A narrative appraisal of the state of the science. Palliative Medicine, 27(10), 918–924.Google Scholar
Ishikawa, Y., Fukui, S., Saito, T., et al. (2013). Family preference for place of death mediates the relationship between patient preference and actual place of death: A nationwide retrospective cross-sectional study. PLoS One, 8(3), e56848. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3592847/.Google Scholar
McCrone, P. (2009). Capturing the costs of end-of-life care: Comparisons of multiple sclerosis, Parkinson's disease, and dementia. Journal of Pain and Symptom Management, 38(1), 62–67.Google Scholar
McFadden, D. (1974). Conditional logit analysis of qualitative choice behavior. In Frontiers in Econometrics. Zarembka, P. (ed.), pp. 105–142. New York: Academic Press. Available from https://eml.berkeley.edu/reprints/mcfadden/zarembka.pdf.Google Scholar
National Institute of Clinical Excellence (2004). Improving Supportive and Palliative Care for Adults with Cancer. Available from https://www.nice.org.uk/guidance/csg4/evidence.Google Scholar
Parker, S.M., Clayton, J.M., Hancock, K., et al. (2007). A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: Patient/caregiver preferences for the content, style, and timing of information. Journal of Pain and Symptom Management, 34(1), 81–93.Google Scholar
Tang, S.T. (2003). When death is imminent: Where terminally ill patients with cancer prefer to die and why. Cancer Nursing, 26(3), 245–251.Google Scholar
Tjur, T. (2009). Coefficients of determination in logistic regression models—a new proposal: The coefficient of discrimination. The American Statistician, 63(4), 366–372.Google Scholar
Weitzen, S., Teno, J.M., Fennell, M., et al. (2003). Factors associated with site of death: A national study if where people die. Medical Care, 41(2), 323–335.Google Scholar
Xia, W., Hwang, S., Chang, V.T., et al. (2005). Validity, reliability and responsiveness of Euroqol (EQ5D) in patients (pts) receiving palliative care (PC). Journal of Clinical Oncology, 23(Suppl. 16), 80–82.Google Scholar
Supplementary material: File

Bannon et al supplementary material

Table S1

Download Bannon et al supplementary material(File)
File 21.2 KB