Factors influencing death at home in terminally ill patients with cancer: systematic review

Abstract

Objectives To determine the relative influence of different factors on place of death in patients with cancer. Data sources Four electronic databases-Medline , PsycINFO (1972PsycINFO ( -2004, CINAHL (1982-2004), and ASSIA (1987-2004; previous contacts with key experts; hand search of six relevant journals. Review methodsWe generated a conceptual model, against which studies were analysed. Included studies had original data on risk factors for place of death among patients, > 80% of whom had cancer. Strength of evidence was assigned according to the quantity and quality of studies and consistency of findings. Odds ratios for home death were plotted for factors with high strength evidence. Results 58 studies were included, with over 1.5 million patients from 13 countries. There was high strength evidence for the effect of 17 factors on place of death, of which six were strongly associated with home death: patients' low functional status (odds ratios range 2.29-11.1), their preferences (2.19-8.38), home care (1.37-5.1) and its intensity (1.06-8.65), living with relatives (1.78-7.85), and extended family support (2.28-5.47). The risk factors covered all groups of the model: related to illness, the individual, and the environment (healthcare input and social support), the latter found to be the most important. Conclusions The network of factors that influence where patients with cancer die is complicated. Future policies and clinical practice should focus on ways of empowering families and public education, as well as intensifying home care, risk assessment, and training practitioners in end of life care.

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

“…1 However, the actual place of death results from a complex interrelationship of individual and environmental factors. 2 In contrast to northern European countries, Italian caregivers are mostly relatives, rather than friends or neighbors. As a consequence, cultural and social attitudes, deficiencies in the health care facilities, or family structure may strongly influence the place of death in a country like Italy.…”

“…A systematic review has shown that six factors were strongly associated with home death: patient's low functional status, their preferences, home care and its intensity, living with relatives, and extended family support. 2 Patient preference as to place of death, level of caregiver support and entitlement to private shift nursing were significantly associated with patients dying at home. 3 However, the complex process of decision making about the place of death is often dynamic and contradictory, 4 and involves the patient, the caregivers, and the professionals, 5 as well as environmental factors including hospital or hospice facilities.…”

“…3 However, the complex process of decision making about the place of death is often dynamic and contradictory, 4 and involves the patient, the caregivers, and the professionals, 5 as well as environmental factors including hospital or hospice facilities. 2 In Italy, death at home was very frequent in early prospective studies, occurring in as many as 86% of deaths; 6 multivariate analysis showed that a higher degree of family support was associated with home death. In a large multicenter study of palliative care units, mostly home care programs, 76% of patients died at home, 7 which was the desired place in 90% of patients.…”

Knowledge and Attitudes toward Palliative Terminal Cancer Care among Thai Generalists

“…Data also suggest that most people with advanced illnesses prefer to be cared for and death at home or near their home (Tang, 2003;Gomes and Higginson, 2006). Yet, most people die in institutions or if at home, without the appropriate level of care needed to meet their basic needs (Kikule, 2003, Docherty et al, 2008.…”

Sterben und Tod im gesellschaftlichen Wandel

“…Wir sterben mehrheitlich in Organisationen, in Krankenhäusern und Pflegeheimen. Internationale Vergleiche zeigen, dass das Ausmaß der Institutionalisierung des Sterbens weiter zuund somit das Sterben zu Hause weiter abnimmt [28,29].…”