Predictive factors for home deaths among cancer patients in Swedish palliative home care

Abstract

Five palliative home care teams participated in a prospective Swedish study that included 221 palliative cancer patients. All patients with incurable malignant disease that were admitted and died during 1999 were included. On admission, demographic data were recorded. When patients, despite ongoing home care, were referred to institutional care, doctors and nurses involved were interviewed about the reasons for this. After the patients' death next of kin involved in the care were interviewed according to a questionnaire. Approximately half of the patients died at home. The reasons for referral showed a wide diversity and included both social and psychosocial factors, medical emergencies and problems related to symptom control. A preference for dying at home and not living alone were shown to be the strongest predictors of home death (p = 0.001). However, 35% of patients living alone died at home. Interestingly enough, Karnofsky performance index (KPI) at admission was significantly lower for those dying at home, despite similar mean time of care. The understanding of impending death was significantly more common among the families of those patients dying at home.

Expectations to and evaluation of a palliative home-care team as seen by patients and carers

“…Studies specifically focussing on palliative home care have additionally focussed on place of death [3,18,55,66], reasons for hospitalisation despite palliative home care [5,9,27] and carers' experiences of caring for a patient at home [7,21,29,41,46,48,54,56,61,67].…”

End-of-life care for nursing home residents dying from cancer in Nova Scotia, Canada, 2000–2003

“…Because females are more likely to be left without a spouse in older age, nursing home care may be more necessary for them as home care cannot as readily be provided for persons living alone at end of life. Palliative cancer patients were more likely to die at home if they were living with a spouse or family member [19].…”

Soins spécifiques et soins de support en cancérologie à domicile: expérience du centre Léon-Bérard sur 751 patients en 2003

“…Lorsque les patients expriment une pré fé rence, ils se prononcent majoritairement pour un dé cè s à domicile alors que la majorité des dé cè s surviennent à l'hô pital [13,26]. Le taux de dé cè s à domicile est assez voisin dans les diffé rents pays occidentaux et proches de celui retrouvé dans notre é tude [1,9,19,23,29]. Ce taux varie de 29 % dans une é tude amé ricaine [19] à 47 % dans une é tude canadienne [9] contre 36 % dans notre é tude.…”