Does Dying at Home Influence the Good Death of Terminal Cancer Patients?

Abstract

To investigate whether dying at home influences the likelihood that a terminal cancer patient will achieve a good death despite the limited medical resources available in many communities, this study investigated the relationship between the achievement of a good death and the performance of good-death services in two groups with different places of death, and explored the possible factors associated with this relationship. Three hundred and seventy-four consecutive patients with terminal cancers admitted to a palliative care unit were enrolled. Two instruments, the good-death scale and the audit scale for good-death services, were used in the study. Mean age of the 374 patients was 65.45 +/- 14.77 years. The total good-death score in the home-death group (n=307) was significantly higher than that in the hospital-death group (n=67), both at the time of admission (t= -5.741, P<0.001) and prior to death (t= -3.027, P<0.01). However, the score of item "degree of physical comfort" assessed prior to death in the home-death group was lower than that in the hospital-death group (P=0.185). As to the audit scale for good-death services, each subscale score and total scores in the home-death group were significantly higher than that in the hospital-death group, with the exception of the subscale "continuity of social support" (4.72 vs. 4.61, P=0.132). Bereavement support (odds ratio=1.01, 95% confidence interval=0.62-1.39; multiple regression), alleviation of anxiety (0.81, 0.46-1.15), decision-making participation (0.61, 0.26-0.95), fulfillment of last wish (0.45, 0.08-0.82), and survival time (0.00, 0.00-0.01) were independent correlates of the good-death score (35.8% of explained variance). However, the place of death was not in the model. The study conclusively suggests the necessity for palliative home care to strengthen the competence of physical care. Moreover, earlier incorporation of palliative care into anticancer therapies can lead to better death preparation and good-death services, and thus be helpful to achieve a good death.

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

“…In one study, the good-death score in the homedeath group was significantly higher than that in the hospital-death group. 22 In another study, there was no indication that dying in an institution or at home involves major differences and quality of dying. 23 Both studies, however, did not analyze the real circumstances of death, which was the main aim of this observational study.…”

Evaluation of Inpatient Multidisciplinary Palliative Care Unit on Terminally Ill Cancer Patients from Providers' Perspectives: A Propensity Score Analysis

“…Each item was appraised on a scale of 1 ¼ 'extremely poor' to 5 ¼ 'extremely good'. The six categories and 12 items were as follows: (1) Reliability and validity of the GDS in Taiwanese palliative care units have been well established (17,18). Cronbach's alpha (a) was used to assess the internal consistency of this good-death measure in the present study and was shown to be 0.71 for the five domains.…”

Validation of a Palliative Prognostic Index to Predict Life Expectancy for Terminally Ill Cancer Patients in a Hospice Consultation Setting in Taiwan

“…Prognostic accuracy helps patients plan the rest of their lives, prepare for death and choose where they want to die (Steinhauser et al, 2001;Adams et al, 2009). Respect for the autonomy of those who wish to die at home was reported to help terminally ill cancer patients in Taiwan achieve a good death (Yao et al, 2007).…”