Actual and preferred place of death of cancer patients. Results from the Italian survey of the dying of cancer (ISDOC)

Abstract

Objective: To describe actual and preferred place of death of Italian cancer patients and to analyse the preferences met regarding the place of death. Design: Mortality follow back survey of 2000 cancer deaths, identified with a two stage probability sample representative of the whole country. Information on patients' experience was gathered from the nonprofessional caregiver with an interview. A section of the interview covered information on the actual and preferred place of death of the patients. Setting: 30 Italian local health districts randomly selected after stratification in four geographical areas. Participants: 1900 of 2000 (95.0%) caregivers of cancer deaths identified. Main outcome measures: Prevalence of actual and preferred places of death. Results: Valid interviews were obtained for 66.9% (n = 1271) of the caregivers. Place of death was home for 57.9% of Italian cancer patients, hospital for 34.6%, hospice for 0.7%, nursing home for 6.5%, and ambulance for 0.4%. Wide and significant differences within Italy were seen (home deaths ranged between 94.0% in the south and 28.2% in the north east). Home was the preferred place of death for 93.5% of patients that expressed a preference, with minimal differences within the country (between 89.5% and 99.0%). Overall 67.1% of the sample died in the place where they preferred to die. Conclusions: Policymakers should encourage health services to focus on ways of meeting individual preferences on place of death. As home was the preferred place of death for most cancer patients, effective programmes to enable the patients to remain at home should be implemented.

How Do Cancer Patients Receiving Palliative Care at Home Die? A Descriptive Study

“…According to caregivers' opinions, home is the preferred place of death for 93.5% of patients. 13 The philosophy of palliative care encourages home death, providing for most of the needs of the caregivers. The expanding role of palliative care, particularly at home, may reduce the number of deaths in inappropriate places, for example, in medical or surgical units where experience with problems that arise when death is imminent is limited.…”

“…As a consequence, cultural and social attitudes, deficiencies in the health care facilities, or family structure may strongly influence the place of death in a country like Italy. 13,14 In a recent national follow-back survey representative of the Italian population, 51% of patients died at home, meaning that many patients were admitted to acute wards unfit to provide end-of-life care. 13 This is the first study reporting the circumstances of the process of death in patients followed at home.…”

“…13,14 In a recent national follow-back survey representative of the Italian population, 51% of patients died at home, meaning that many patients were admitted to acute wards unfit to provide end-of-life care. 13 This is the first study reporting the circumstances of the process of death in patients followed at home. Data were based on reports of home care physicians and interviews with the patients' principal caregivers after their death.…”

Factors Associated with End-of-Life Health Service Use in Patients Dying of Cancer

“…There is also a discrepancy between what patients report as their preferred place of death (most often home) and actual place of death (Beccaro et al 2006;Bruera et al 2003;Burge et al 2003;Foreman et al 2006;gilbar and steiner 1996;karlsen and Addington-Hall 1998;Mcwhinney et al 1995;Heyland et al 2000;Pritchard et al 1998). People who die in institutions such as acute care facilities have unmet needs for symptom control, physician communication, emotional support and respectful treatment compared with those receiving patientcentred palliative care services at home (Teno et al 2004).…”

Opioid Switching in Patients With Advanced Cancer Followed at Home. A Retrospective Analysis

“…The home setting has been reported to be preferred by most patients and relatives and seems to be the favored place of death. 2 In a large sample of patients, a managed home care system has been found to enable patients to receive adequate pain treatment in the comfort of their own homes. Pain control was unsuccessful in a minority of patients.…”