Discharge to home from a palliative care unit: impact on survival and factors associated with home death after the discharge: a cohort study

Abstract

Background Staying at home during the dying process is important for many patients; and palliative care units (PCUs) can help facilitate home death. This study compared patient survival between those who were discharged to home from a palliative care unit and those who were not, and aimed to identify the factors associated with home death after the discharge. Methods This retrospective cohort study used a database of patients admitted to a palliative care unit at Kouseiren Takaoka Hospital in Japan. All consecutive patients admitted to the hospital’s PCU between October 2016 and March 2020 were enrolled. Patient survival and factors potentially associated with survival and place of death were obtained. A total of 443 patients with cancer were analyzed, and 167 patients were discharged to home and 276 were not. Results Propensity score matching analyses revealed that median survival time was significantly longer in patients who were discharged to home than those who were not (57 vs. 27 days, P < 0.001). Multiple logistic regression analysis identified that worse Palliative Prognostic Index (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.03–1.44, p = 0.025) and family members’ desire for home death (OR = 6.30, 95% CI = 2.32–17.1, p < 0.001) were significantly associated with home death after their discharge. Conclusions Discharge to home from palliative care units might have some positive impacts on patient survival.