Differences in place of death between lung cancer and COPD patients: a 14-country study using death certificate data

Cohen, Joachim; Beernaert, Kim; Block, Lieve Van den; Morin, Lucas; Hunt, Katherine; Miccinesi, Guido; Cardenas‐Turanzas, Marylou; Onwuteaka-Philipsen, Bregje D.; MacLeod, Rod; Ruíz-Ramos, Miguel; Wilson, Donna M.; Loučka, Martin; Csikós, Ágnes; Rhee, YongJoo; Teno, Joan M.; Ko, Winne; Deliëns, Luc; Houttekier, Dirk

doi:10.1038/s41533-017-0017-y

Cited by 53 publications

(48 citation statements)

References 41 publications

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“…People with non-cancer conditions were more likely to choose this option. This diverges from provision in many countries: people with non-cancer conditions have low access to inpatient hospice or palliative care units [ 36 – 39 ]. We found that most people who wanted to die at home actually died in a palliative care unit or inpatient hospice.…”

Section: Discussionmentioning

confidence: 99%

Social and clinical determinants of preferences and their achievement at the end of life: prospective cohort study of older adults receiving palliative care in three countries

Daveson²,

et al. 2017

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BackgroundAchieving choice is proposed as a quality marker. But little is known about what influences preferences especially among older adults. We aimed to determine and compare, across three countries, factors associated with preferences for place of death and treatment, and actual site of death.MethodsWe recruited adults aged ≥65-years from hospital-based multiprofessional palliative care services in London, Dublin, New York, and followed them for >17 months. All services offered consultation on hospital wards, support for existing clinical teams, outpatient services and received funding from their National Health Service and/or relevant Insurance reimbursements. The New York service additionally had 10 inpatient beds. All worked with and referred patients to local hospices. Face-to-face interviews recorded most and least preferred place of death, treatment goal priorities, demographic and clinical information using validated questionnaires. Multivariable and multilevel analyses assessed associated factors.ResultsOne hundred and thirty eight older adults (64 London, 59 Dublin, 15 New York) were recruited, 110 died during follow-up. Home was the most preferred place of death (77/138, 56%) followed by inpatient palliative care/hospice units (22%). Hospital was least preferred (35/138, 25%), followed by nursing home (20%) and home (16%); hospice/palliative care unit was rarely least preferred (4%). Most respondents prioritised improving quality of life, either alone (54%), or equal with life extension (39%); few (3%) chose only life extension. There were no significant differences between countries. Main associates with home preference were: cancer diagnosis (OR 3.72, 95% CI 1.40–9.90) and living with someone (OR 2.19, 1.33–3.62). Adults with non-cancer diagnoses were more likely to prefer palliative care units (OR 2.39, 1.14–5.03). Conversely, functional independence (OR 1.05, 1.04–1.06) and valuing quality of life (OR 3.11, 2.89–3.36) were associated with dying at home. There was a mismatch between preferences and achievements – of 85 people who preferred home or a palliative care unit, 19 (25%) achieved their first preference.ConclusionAlthough home is the most common first preference, it is polarising and for 16% it is the least preferred. Inpatient palliative care unit emerges as the second most preferred place, is rarely least preferred, and yet was often not achieved for those who wanted to die there. Factors affecting stated preferences and met preferences differ. Available services, notably community support and palliative care units, require expansion. Contrasting actual place of death with capacity for meeting patient and family needs may be a better quality indicator than simply ‘achieved preferences’.Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0648-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Social and clinical determinants of preferences and their achievement at the end of life: prospective cohort study of older adults receiving palliative care in three countries

Daveson²,

et al. 2017

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“…21,22 leading to poorer quality end of life care. 23 People with COPD are more likely to die in a hospital setting compared with people with lung cancer, 24 which is against the general preference to die at home. 25 In a UK population-based study spanning 14 years, 67% of people with COPD died in hospital whilst 20% died at home, and <1% died in a hospice setting.…”

Section: Introductionmentioning

confidence: 99%

Palliative care and management of troublesome symptoms for people with chronic obstructive pulmonary disease

et al. 2017

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People with advanced chronic obstructive pulmonary disease (COPD) have distressing physical and psychological symptoms, often have limited understanding of their disease, and infrequently discuss end-of-life issues in routine clinical care. These are strong indicators for expert multidisciplinary palliative care, which incorporates assessment and management of symptoms and concerns, patient and caregiver education, and sensitive communication to elicit preferences for care towards the end of life. The unpredictable course of COPD and the difficulty of predicting survival are barriers to timely referral and receipt of palliative care. Early integration of palliative care with respiratory, primary care, and rehabilitation services, with referral on the basis of the complexity of symptoms and concerns, rather than prognosis, can improve patient and caregiver outcomes. Models of integrated working in COPD could include: services triggered by troublesome symptoms such as refractory breathlessness; short-term palliative care; and, in settings with limited access to palliative care, consultation only in specific circumstances or for the most complex patients.

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“…It is thus substantially harder for clinicians to make precise prognoses for patients with organ failure or a disease associated with frailty than for cancer patients. In addition, the unexpected acute exacerbation of a non-cancer disease is less likely to be recognized as a terminal phase [ 14 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Differences in do-not-resuscitate orders, hospice care utilization, and late referral to hospice care between cancer and non-cancer decedents in a tertiary Hospital in Taiwan between 2010 and 2015: a hospital-based observational study

et al. 2018

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BackgroundIn 2009, the Taiwanese national health insurance system substantially expanded hospice coverage for terminal cancer patients to include patients with end-stage brain, dementia, heart, lung, liver, and kidney diseases. This study aimed to evaluate differences in do-not-resuscitate (DNR) status and hospice care utilization between terminal cancer patients and advanced non-cancer patients after the policy change.MethodsData were obtained from the Death and Hospice Palliative Care Database of Taipei Veterans General Hospital in Taiwan. The differences between cancer and non-cancer patients who died in this hospital between 2010 and 2015 were analyzed in terms of patient characteristics, rates of DNR orders, hospice care utilization, number of living days after DNR order, duration of survival (DOS) after hospice care enrollment, and the rate of late referral to hospice care.ResultsData for 8459 patients who died of cancer and major non-cancer terminal diseases were included. DNR order rate, hospice care utilization rate, and DOS were significantly higher for cancer patients than for non-cancer patients (p < 0.001, p < 0.001, and p < 0.001, respectively). The number of living days after DNR order and the late referral rate were significantly higher for non-cancer decedents than for cancer decedents (p < 0.001 and p < 0.001, respectively). From 2010 to 2015, there were significantly increasing trends in the hospice utilization rate, number of living days after DNR order, and rate of late referral for the cancer group (p < 0.001, p = 0.001, and p < 0.001, respectively). For the non-cancer group, there were significantly increasing trends in the rate of DNR order, hospice utilization rate, and number of living days after DNR order (p < 0.001, p < 0.001, and p = 0.029, respectively).ConclusionsFurther guidelines should be developed to help clinicians to promptly refer terminal cancer and non-cancer patients to hospice care. Considering the lower hospice utilization rate and the growing need for hospice care among terminal non-cancer patients, policymakers should consider how to improve the relevant levels of professional care to enhance the accessibility and availability of hospice care in Taiwan.

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Differences in place of death between lung cancer and COPD patients: a 14-country study using death certificate data

Cited by 53 publications

References 41 publications

Social and clinical determinants of preferences and their achievement at the end of life: prospective cohort study of older adults receiving palliative care in three countries

Social and clinical determinants of preferences and their achievement at the end of life: prospective cohort study of older adults receiving palliative care in three countries

Palliative care and management of troublesome symptoms for people with chronic obstructive pulmonary disease

Differences in do-not-resuscitate orders, hospice care utilization, and late referral to hospice care between cancer and non-cancer decedents in a tertiary Hospital in Taiwan between 2010 and 2015: a hospital-based observational study

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