Patient Preferences versus Family Physicians' Perceptions Regarding the Place of End-of-Life Care and Death: A Nationwide Study in Taiwan

Abstract

Background: Enabling people to die in their preferred place is important for providing high-quality end-of-life care. Objective: The study objective was to explore patients' preferences regarding the place of end-of-life care and death and to compare these preferences with the perceptions of their family physicians. Methods: This cross-sectional study used stratified random sampling, surveying 400 registered patients and 200 of their family physicians nationwide, with a five-part, structured, self-report questionnaire. Results: Of the selected population, 310 patients (response rate 77.5%) and 169 physicians (response rate 84.5%) responded. Regarding the preferred place for end-of-life care, most of the patients would choose to receive care at home (60.6%) if home care services were available. Additionally, home was the most frequently preferred (66.5%) place of death. The family physicians' survey showed that a higher proportion of physicians selected home as the preferred place for end-of-life care and death (71.6% and 87.2%, respectively). The results of logistic regression analysis showed that patients younger than 50 years of age who believed in Chinese folk religion and who resided in a rural area were more likely to prefer to die at home. Conclusions: The most commonly preferred place for end-of-life care and death is the patient's home. Establishing a community-based palliative care system should be encouraged to allow more individuals to die in their preferred locations. There were discrepancies in the preferred place of end-of-life care and death between the patients' preferences and their family physicians' perceptions. More effective physician-patient communication regarding end-of-life care is needed.

Needs of patient with advanced stages of cancer in a Thai community

“…The place of death is a major theme among patients in palliative care delivery research. Most patients at the end of life prefer dying at home [14]. The result demonstrated the greatest needs of a majority of patients that they require better understanding about their diseases, prognosis and medical treatment.…”

“…The ultimate goal is to provide patients and families with the best QOL during the trajectory of diseases [11]. The data from previous studies showed that many terminally ill patients would prefer to stay and die in their own homes, but unfortunately some of patients may not be able to do so [11][12][13][14]. Evidence has presented many benefits of home care for palliative care patients.…”

A Study of the Association Between Multidisciplinary Home Care and Home Death Among Thai Palliative Care Patients

“…The data from previous studies showed that many terminally ill patients would prefer to stay and die in their own homes, but unfortunately, some patients may not be able to do so. [1][2][3][4][5][6] Even though there are many factors associated with successful home deaths (ie, the patient's or family's preference, the patient's performance status during the last days, the patient's awareness of the disease status and prognosis), receiving palliative home visits from the multidisciplinary care teams is one of the key factors that enable patients to die at home. [7][8][9][10][11] Previous evidence has supported many benefits of home care for palliative care patients.…”

Eliciting and honouring end-of-life care preferences : a multiple methods study on place of death

“…On the other hand, in Taiwan, the rates of home death preferences were almost as high as those observed in European countries, although the underlying rationale could not be more different. A survey carried out with patients registered with family physician clinics found that home was the preferred location of death by 67% of the respondents (Shih et al, 2015). Despite strong reservations about burdening the family to fulfill their wish to die at home (Shih et al, 2015), the majority of cancer patients surveyed in a separate study also preferred home as the place of death (C.…”

“…If death were to occur outside of the home, for instance, in the hospital, it is believed that the spirit might become a wandering and forsaken ghost (S.-Y. Cheng et al, 2015;Shih et al, 2015).…”