Impact on place of death in cancer patients: a causal exploration in southern Switzerland

Abstract

Background Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care. Methods A data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review. Results Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family’s preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient’s preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%. Conclusion Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family’s decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.

Preferred Place of Death in Adult Cancer Patients: A Systematic Review and Meta-Analysis

“…Psychological factors influencing the preferred place of death in cancer patients was including not imposing burden on family and other caregivers (Lee and Pang, 1998;Kui et al, 2005;Tang et al, 2005;Yamagishi et al, 2012), Patients' level of anxiety (Skorstengaard et al, 2017), awareness of the incurability of the disease (Gomes et al, 2015), participation or non-participation of social workers (Kern et al, 2020), Being with the family in the last days of life (Kui et al, 2005), having independence in doing daily tasks at the end of life (Tang et al, 2005(Tang et al, , 2006, environmental security (Lee and Pang, 1998) and intimacy and emotional connection with family members (Lee and Pang, 1998).…”

“…In 2018, about 9.6 million people of the world have died by cancer, which was almost one in six worldwide deaths (WHO, 2021). Of these, approximately 1.6 million patients did not die in their preferred place (Kern et al, 2020). Patients with advanced cancer show that despite the fact that the majority of cancer patients prefer to die in the preferred place (Neergaard et al, 2011;Hyun et al, 2013;Gomes et al, 2015;Vidal et al, 2020), a small number of these patients die in the preferred place (Chen et al, 2014;Howell et al, 2017).…”

Faktorer som påvirker kreftpasientens muligheter for å dø hjemme – en systematisk oversiktsartikkel

“…Av de inkluderte studiene var det en med randomisert kontrollert (RCT) (35) design, og en pilotstudie med to ulike studiefaser (36). Ellers inkluderte vi ni retrospektive tverrsnittstudier (4,8,13,(37)(38)(39)(40)(41)(42), og åtte kohortstudier (43)(44)(45)(46)(47)(48)(49)51). Alle studiene ble publisert mellom 2010 og 2020.…”

“…Majoriteten var menn (36,(39)(40)(41)(42)(43)47,48). Tverrfaglige palliative team var representert i tolv studier (13,35,36,39,40,43,45,46,48,51) (tabell 3).…”

“…RRCP-HPC informasjons delings verktøy (Regional Referral Clinical Pathway for Homebased Palliativ Care) mens flere benyttet en kortversjon av Good Death Inventory (GDI) (13,35,37,39,40,42,45,46,48,49,51) (se tabell 5). Bruken av studiespesifikt spørreskjema med uklar validitet er gjennomgående (4,8,13,(41)(42)(43)45,47,51).…”