Although the place of death of patients with terminal cancer is influenced by multiple factors, few studies have systematically investigated its determinants. The purpose of this study was to examine the influence of the patients' sociodemographic, clinical and support network variables on the place of death of terminally ill cancer patients under the care of home care agencies in Japan. Among 528 patients from 259 home care agencies, 342 (65%) died at home and 186 (35%) died at a hospital. From the multivariate logistic regression model, patients who expressed the desire for receiving home care at referral [odds ratio (OR), 95% confidence interval (CI): 2.19, 1.09-4.40] in addition to the family caregiver's desire for the same (OR, 95%CI: 3.19, 1.75-5.81), who had more than one family caregiver (OR, 95%CI: 2.28, 1.05-4.94), who had the support of their family physician (OR, 95%CI: 2.23, 1.21-4.08), who were never rehospitalized (OR, 95%CI: 0.04, 0.02-0.07), who received more home visits by the home hospice nurse during the stable phase under home hospice care (OR, 95%CI: 1.25, 1.02-1.53), and who were in the greatest functionally dependent status during the last week prior to death (OR, 95%CI: 8.60, 4.97-14.89) were more likely to die at home. Overall, this model could accurately classify 95% of the places of death, which is higher than other published studies. A clearer understanding of factors that might influence the place of death of terminally ill cancer patients would allow healthcare professionals to modify healthcare systems and tailor effective interventions to help patients die at their place of preference.

Sleep debt on weekdays in Japanese white-collar workers, estimated using a questionnaire, was associated with age, overtime, and self-rated workload.

In the practice of home hospice care, death education for both patient and family is extremely important, although little information on its usefulness is available. In this study, the effects of death education under home hospice care were analyzed for 16 patients who died at home. Death education for the patient and his/her family was given at least once in each phase of care, and at least four times in total. The acceptance of death by the patients was judged according to the way they spent their remaining time, to their attitudes, and to their hope for a life after death. Fourteen of 15 patients appeared to accept their own death. An autopsy was performed in five of the 16 cases. In one case, the doctor recommended an autopsy to the family; in the other cases, it was performed in accordance with the patient's or family's wish. As the goal of death education in home hospice care is the acceptance of death by both patient and family, our methods of death education appear to be effective.

Several detailed analyses of factors associated with prognosis disclosure were conducted. Japanese physicians need to carefully communicate with the patients individually about whether direct disclosure or disclosure primarily to the family is preferred.

No abstract