Congruence between preferred and actual place of death according to the presence of malignant or non-malignant disease: a systematic review and meta-analysis

Billingham, Matthew James; Billingham, Sarah-Jane

doi:10.1136/bmjspcare-2012-000292

Cited by 90 publications

(82 citation statements)

References 40 publications

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“…Although patient surveys show that the home environment is the preferred place of death, in reality hospital is by far the most frequent location [6–8]. …”

Section: Introductionmentioning

confidence: 99%

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014

et al. 2017

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BackgroundCancer care including aggressive treatment procedures during the last phase of life in patients with incurable cancer has increasingly come under scrutiny, while integrating specialist palliative care at an early stage is regarded as indication for high quality end-of-life patient care.AimTo describe the demographic and clinical characteristics and the medical care provided at the end of life of cancer patients who died in a German university hospital.MethodsRetrospective cross-sectional study on the basis of anonymized hospital data for cancer patients who died in the Munich University Hospital in 2014. Descriptive analysis and multivariate logistic regression analyses for factors influencing the administration of aggressive treatment procedures at the end of life.ResultsOverall, 532 cancer patients died. Mean age was 66.8 years, 58.5% were men. 110/532 (20.7%) decedents had hematologic malignancies and 422/532 (79.3%) a solid tumor. Patients underwent the following medical interventions in the last 7/30 days: chemotherapy (7.7%/38.3%), radiotherapy (2.6%/6.4%), resuscitation (8.5%/10.5%), surgery (15.2%/31.0%), renal replacement therapy (12.0%/16.9%), blood transfusions (21.2%/39.5%), CT scan (33.8%/60.9%). In comparison to patients with solid tumors, patients with hematologic malignancies were more likely to die in intensive care (25.4% vs. 49.1%; p = 0.001), and were also more likely to receive blood transfusions (OR 2.21; 95% CI, 1.36 to 3.58; p = 0.001) and renal replacement therapy (OR 2.65; 95% CI, 1.49 to 4.70; p = 0.001) in the last 7 days of life. Contact with the hospital palliative care team had been initiated in 161/532 patients (30.3%). In 87/161 cases (54.0%), the contact was initiated within the last week of the patient’s life.ConclusionsOverambitious treatments are still reality at the end of life in cancer patients in hospital but patients with solid tumors and hematologic malignancies have to be differentiated. More efforts are necessary for the timely inclusion of specialist palliative care.

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“…Although patient surveys show that the home environment is the preferred place of death, in reality hospital is by far the most frequent location [6–8]. …”

Section: Introductionmentioning

confidence: 99%

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014

et al. 2017

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“…A clearly defined list of what constitutes palliative care needs, or at what point in the disease trajectory this occurs, is not available 14. There is congruence of opinion that palliative care needs include a combination of symptom control, psychological support, comfort care, end-of-life planning, shared decision-making, spiritual or religious issues, family and relational support, treatment limitation discussions and orders 1 3 5 10 13–25. These needs are relevant for patients with both cancer and non-cancer conditions 11.…”

Section: Introductionmentioning

confidence: 99%

A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital

Milnes

Orford

Berkeley

et al. 2015

BMJ Support Palliat Care

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“…However, patients infrequently die in their preferred location. 9 There is variation between studies in the proportion of people who prefer to be cared for at home (25%-87%) or in a hospice (9%-30%) at EOL. 2 Despite hospitals being the most common place of death in many countries, few choose to be cared for in these facilities.…”

mentioning

confidence: 99%

The Right Place at the Right Time: Medical Oncology Outpatients' Perceptions of Location of End-of-Life Care

Waller¹,

Sanson‐Fisher²,

Zdenkowski³

et al. 2018

J Natl Compr Canc Netw

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Background: Helping people achieve their preferred location of care is an important indicator of quality end-of-life (EOL) care. Using a sample of Australian medical oncology outpatients, this study examined (1) their preferred location of EOL care; (2) their perceived benefits and worries of receiving care in that location; (3) the percentage who had discussed preferences with their doctor and/or support person; and (4) whether they wanted their doctor to ask them where they wanted to die. Methods: Adults with a confirmed diagnosis of cancer were approached between September 2015 and January 2016 in the waiting room of an Australian oncology outpatient clinic. Consenting participants completed a home-based pen-and-paper survey indicating preferred location of care, perceived benefits and worries of that location, whether they had discussed preferences with their doctors, and whether they were willing to be asked about their preferences. Results: A total of 203 patients returned the survey (47% of those eligible). Less than half preferred to be cared for at home (47%), 34% preferred a hospice/palliative care unit, and 19% preferred the hospital. Common benefits and worries associated with locations included perceived burden on others, familiarity of environment, availability of expert medical care, symptom management, and likelihood of having wishes respected. More patients had discussed preferences with their support persons (41%) than doctors (7%). Most wanted a doctor to ask them about preferred location of care (87%) and thought it was important to die in the location of their choice (93%). Conclusions: Patients were willing to have clinicians to ask them where they wanted to die, although few had discussed their preferences with doctors. Although home was the most preferred location for many patients, the overall variation suggests that clinicians should adopt a systematic approach to eliciting patient preferences. J Natl Compr Canc Netw 2018;16(1):35-41 doi: 10.6004/jnccn.2017.7025 Research into location of end-of-life (EOL) care offers insight into whether people are accessing resources that aim to improve quality of dying and support appropriate service planning. 1 A recent population-level study of patients with cancer in 14 countries reported that between 12% and 57% of patients die at home and between 22%

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Congruence between preferred and actual place of death according to the presence of malignant or non-malignant disease: a systematic review and meta-analysis

Cited by 90 publications

References 40 publications

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014

A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital

The Right Place at the Right Time: Medical Oncology Outpatients' Perceptions of Location of End-of-Life Care

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