Determinants of place of Death for recipients of Home-Based Palliative Care

Abstract

Introduction: Health system restructuring combined with the preferences of many terminally ill care recipients and their caregivers has led to an increase in home-based palliative care, yet many care recipients die within institutional settings such as hospitals. This study sought to determine the place of death and its predictors among palliative care patients with cancer. Methods: Study participants were re cruited from the Temmy Latner Centre for Palliative Care, a regional palliative care program based in Toronto, Canada. A total of 137 patients and their family caregivers participated in the study; application of various exclusion criteria restricted analysis to a sub-sample of 110. Bivariate (chi-square) and multivariate (logistic regression) analyses were conducted. Results: 66 percent of participants died at home. Chisquare analysis indicated that women were more likely to die at home than men; multivariate analysis indicated that women and those living with others were significantly more likely to die at home than men or those who lived alone. Conclusion: Place of death is influenced by the socio-demographic characteristics of patients, the characteristics of their caregivers, and health service factors. Palliative care programs need to tailor services to men and those living alone in order to reduce institutional deaths.

A Study of the Association Between Multidisciplinary Home Care and Home Death Among Thai Palliative Care Patients

“…9,11,22,[27][28][29] The data from our study were in contrast with those of the previous national survey, which showed that half of the patients following the CSMBS died in public hospitals. 16 We found no such association between the types of health-care insurance and home death.…”

Predictors of Health Service Use Over the Palliative Care Trajectory

“…Assessment of the reliability and validity of the AHCR demonstrated that there was agreement between participants' reports and administrative data (kappa ranging from 0.41 to 1.00). 10 The AHCR has been used in numerous other studies, for a wide range of patient populations and clinical settings 7,[11][12][13][14][15][16][17] The Palliative Performance Scale (PPS) was used to collect data on functional and cognitive status of the patient during each caregiver interview. 18 The PPS assesses the physical functioning in ambulation, activity, and evidence of disease, ability for self-care, intake (i.e., person's eating habits), and level of consciousness.…”

A Literature Review on Care at the End-of-Life in the Emergency Department

“…The paradox is that while there is strong evidence suggesting that the majority of such patients do not want to die either in the ED, ICU or hospital ward, there is very limited information about strategies for out of hospital care in the ED [3, 70, 79, 142, 147, 148]. …”