Place of Death and the Differences in Patient Quality of Death and Dying and Caregiver Burden

Background: Cancer caregivers are key stakeholders in the final weeks of life and in bereavement. Research has highlighted end-of-life (EOL) factors important to caregivers, as well as factors contributing to caregiver mental health and bereavement outcomes. There has been limited data on factors predicting caregiver perceptions of quality of EOL care. Objective: This study's purpose was to identify modifiable predictors of caregivers' Caregiver Evaluation of Quality of End of Life Care (CEQUEL) scores, with the broader aim of informing clinical interventions to improve caregiver impressions of care and subsequent bereavement adjustment. Methods: Study data came from Coping with Cancer I (CwC1). CwC1 investigators interviewed advanced cancer patients and caregivers prior to the patient's death (Wave 1) and reinterviewed caregivers following the death (Wave 2) (N = 275 dyads). The authors identified potential Wave 1 predictors of CEQUEL scores and performed a series of linear regression analyses to identify a parsimonious predictive model using corrected Akaike's Information Criterion (AICc) values. Results: In adjusted analyses, caregivers rated quality of care as poorer when patients died in a hospital (B = -1.40, SE = 0.40, p = 0.001) (B, unstandardized regression coefficient; SE, standard error) or had less than one week of inpatient hospice care (B = -1.98, SE = -0.70, p = 0.006). Whole-person physician care and caregiver religiosity were associated with perceived higher quality of care in unadjusted, but not adjusted, analyses. Conclusions: Findings suggest that place of death and hospice length of stay best predict bereaved caregiver evaluations of quality of EOL care. These findings equip health care providers with modifiable targets to improve caregivers' experience of EOL care and subsequent bereavement.

show abstract

“…14,48 A number of studies have further highlighted the detrimental impact of EOL decision making in the hospital on caregiver mental health.…”

Section: Discussionmentioning

confidence: 99%

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

Higgins

Garrido

Prigerson

2015

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…Having timely end-of-life discussions (EOLds) with advanced cancer patients is essential; multiple empirical studies demonstrate that EOLds reduce unnecessary aggressive care near death, provide end-of-life (EOL) care consistent with patients' preferences, increase early hospice referrals, and improve patients' quality of life [1][2][3][4][5]. Many physicians, however, do not actually discuss EOL options with advanced cancer patients until they are in the terminal phase of life [6,7].…”

Section: Introductionmentioning

confidence: 99%

A National Survey to Systematically Identify Factors Associated With Oncologists’ Attitudes Toward End-of-Life Discussions: What Determines Timing of End-of-Life Discussions?

et al. 2015

Self Cite

View full text Add to dashboard Cite

Background. End-of-life discussions (EOLds) occur infrequently until cancer patients become terminally ill. Methods. To identify factors associated with the timing of EOLds, we conducted a nationwide survey of 864 medical oncologists. We surveyed the timing of EOLds held with advanced cancer patients regarding prognosis, hospice, site of death, and do-not-resuscitate (DNR) status; and we surveyed physicians' experience of EOLds, perceptions of a good death, and beliefs regarding these issues. Multivariate analyses identified determinants of early discussions. Results. Among 490 physicians (response rate: 57%), 165 (34%), 65 (14%), 47 (9.8%), and 20 (4.2%) would discuss prognosis, hospice, site of death, and DNR status, respectively, "now" (i.e., at diagnosis) with a hypothetical patient with newly diagnosed metastatic cancer. In multivariate analyses, determinants of discussing prognosis "now" included the physician perceiving greater importance of autonomy in experiencing a good death (odds ratio [OR]: 1.34; p 5 .014),

show abstract

“…Although this was not an endpoint of this study, our study suggests that many patients with HNC die in an acute hospital. Generally, death in the acute hospital setting is less preferable than in a hospice or at home (28). Thus, we could say that quality of dying in HNC patients in Japan remains poor.…”

Section: Discussionmentioning

confidence: 99%

Quality of life and functional status of terminally ill head and neck cancer patients: a nation-wide, prospective observational study at tertiary cancer centers in Japan

Shinozaki

Ebihara²,

Iwase

et al. 2016

Jpn. J. Clin. Oncol.

Self Cite

View full text Add to dashboard Cite

Background: Little is known about quality of life and functional status of patients with terminally ill head and neck cancers. Methods: We conducted a multicenter, prospective, observational study to examine quality of life and functional status in terminally ill head and neck cancer patients. Results: Of the 100 patients meeting inclusion criteria, 72 were observed until death. There was no significant difference in the quality of life score between baseline and Week 3. Forty patients (54.9%) could speak and 22 patients (30.5%) could have oral intake upon study entry. Fifty-three patients (74.6%) received enteral nutrition. Twenty-six patients (36.6%) required dressing changes for fungating tumors. The route of nutritional intake (nasogastric tube vs. percutaneous gastric tube) might be predictive for the duration of hospital stay (64 vs. 21 days, P = 0.0372). Conclusion: There was no significant relationship between quality of life and functional status seen in this study. Feeding tube type could have the most impact on quality of life.

show abstract

Place of Death and the Differences in Patient Quality of Death and Dying and Caregiver Burden

Abstract: Dying at home may contribute to achieving good death in terminally ill patients with cancer without causing remarkably increased caregiver burden. Place of death should be regarded as an essential goal in end-of-life care.

Cited by 135 publications

References 30 publications

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

A National Survey to Systematically Identify Factors Associated With Oncologists’ Attitudes Toward End-of-Life Discussions: What Determines Timing of End-of-Life Discussions?

Quality of life and functional status of terminally ill head and neck cancer patients: a nation-wide, prospective observational study at tertiary cancer centers in Japan

Contact Info

Product

Resources

About