Predictors for place of death among children:A systematic review and meta-analyses of recent literature

Wolff, Sanne Lausen; Christiansen, Christian Fynbo; Nielsen, Mette Kjærgaard; Johnsen, Soeren Paaske; Schrøeder, Henrik; Neergaard, Mette Asbjoern

doi:10.1007/s00431-020-03689-2

Cited by 13 publications

(13 citation statements)

References 43 publications

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“…Challenges in identifying the terminal phase of an illness may be associated with less opportunity or desire for a home death. 4 , 11 …”

Section: Discussionmentioning

confidence: 99%

“… 10 , 13 However, consistent with our study, a recent meta-analysis found that those living in neighbourhoods with the lowest income quintiles were more likely to die in hospital. 11 Across studies, it is unclear what mechanisms may underlie this disparity; however, patient and family preference, system issues, provider biases or some combination of these factors may be at play. 14 In one Canadian study of 75 children with cancer, lower income was associated with parent preference for death in hospital.…”

Section: Discussionmentioning

confidence: 99%

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Location of death among children with life-threatening conditions: a national population-based observational study using the Canadian Vital Statistics Database (2008–2014)

Widger¹,

Brennenstuhl²,

Tanuseputro³

et al. 2023

cmajo

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Background: Patterns in location of death among children with life-threatening conditions (e.g., cancer, genetic disorders, neurologic conditions) may reveal important inequities in access to hospital and community support services. We aimed to identify demographic, socioeconomic and geographic factors associated with variations in location of death for children across Canada with life-threatening conditions. Methods: We used a retrospective observational cohort design and the Canadian Vital Statistics Database to identify children aged 19 years or younger who died from a life-threatening condition between Jan. 1, 2008, and Dec. 31, 2014. We used multivariable logistic regression to determine predictors of in-hospital death for children aged 1 month to 19 years, and for neonates younger than 1 month. Results: Overall, 13 115 decedents younger than 19 years had life-threatening conditions. Of 5250 children and 7865 neonates, 74.2% and 98.1%, respectively, died in hospital. Among children, we found a higher proportion of hospital deaths in the lowest (v. highest) income quintile (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.28–1.97), and a lower proportion among children living more than 400 km (v. < 50 km) from a pediatric hospital (OR 0.73, 95% CI 0.65–0.86). Compared with Ontario, hospital death was most common in Quebec (OR 1.38, 95% CI 1.14–1.67) and least common in British Columbia (OR 0.43, 95% CI 0.34–0.53). Compared with an oncologic cause of death, all causes except neurologic and metabolic conditions had significantly higher odds of dying in hospital. Interpretation: In addition to demographics, we identified socioeconomic and geographic differences in location of death, suggesting potential inequities in access to high-quality care at the end of life. Health care policies and practices must ensure equitable access to services for children across Canada, particularly at the end of their life.

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“…Challenges in identifying the terminal phase of an illness may be associated with less opportunity or desire for a home death. 4 , 11 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Location of death among children with life-threatening conditions: a national population-based observational study using the Canadian Vital Statistics Database (2008–2014)

Widger¹,

Brennenstuhl²,

Tanuseputro³

et al. 2023

cmajo

View full text Add to dashboard Cite

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“…Most terminally ill children and their families prefer to die at home (Castor et al, 2018; Stilwell et al, 2020), but the majority of children die in hospitals (Håkanson et al, 2017; Wolff et al, 2020). According to the mothers' statements, there was no environment at home where they could continue to care for their children, and only one child, realising that her pain did not go away at home, reluctantly wanted to go to the hospital.…”

Section: Discussionmentioning

confidence: 99%

Desires vs. conditions: A qualitative study exploring the factors affecting the place of death of child with cancer in Turkey

Bingöl

Aydın

Kebudi

et al. 2022

European J Cancer Care

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Objective: The purpose of this study was to describe factors affecting the place of death of children with cancer at the end of life. Methods:The descriptive phenomenological approach was used. Eighteen mothers who lost their children to cancer participated in in-depth interviews. Data were analysed using MAXQDA software version. Codes and categories were developed inductively from participants' narratives. Results:The factors affecting the place of death of children were categorised into two main themes: (1) desires and (2) conditions. Most of the mothers reported that their deceased children wanted to be with their families at the end of life and they wanted to go home. The conditions related to health services were defined as the barriers to the death of their children in the places of death preferred by the mothers. Conclusion:The desire to be close to the child was the main factor affecting the parents' decisions. The findings revealed the prevailing circumstances in the death place decision beyond parental desires. These were the child's health conditions, physical conditions of hospitals, and the lack of home care and paediatric palliative care services, which were factors related to the system, and the lack of other options for parents.

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“…We have previously conducted a systematic review investigating the predictors of place of death among children. This review showed that the odds of dying at home were twice as high among children with cancer compared to children with non‐cancerous conditions 13 . Understanding how treatment trajectories differ between diagnoses and extending this knowledge beyond paediatric oncology may contribute to illuminate whether targeted efforts are needed to ensure optimal EOL care for every dying child.…”

Section: Introductionmentioning

confidence: 99%

“…This review showed that the odds of dying at home were twice as high among children with cancer compared to children with non-cancerous conditions. 13 Understanding how treatment trajectories differ between diagnoses and extending this knowledge beyond paediatric oncology may contribute to illuminate whether targeted efforts are needed to ensure optimal EOL care for every dying child. The aim of this study was to compare frequencies of indicators of HI-EOL among children according to the underlying causes of death.…”

Section: Introductionmentioning

confidence: 99%

Disparities in intensity of treatment at end‐of‐life among children according to the underlying cause of death

et al. 2021

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Aim To compare indicators of high‐intensity treatment at end‐of‐life (HI‐EOL) among children according to causes of death. Methods We conducted a nationwide registry study in Denmark among 938 children of 1‐17 years of age who died from natural causes from 2006 to 2016. We identified and compared indicators of HI‐EOL within the last month of life across diagnoses. Indicators were hospital admissions, days in hospital, intensive care unit admission, mechanical ventilation, and hospital death. Results Proportions of each indicator of HI‐EOL ranged from 27% to 75%. The most common indicators were hospital death (75%) and ICU admission (39%). Compared to children with solid tumours, children with non‐cancerous conditions had an adjusted odds ratio of 3.5 (95% CI 2.1‐5.9) of having ≥3 indicators of HI‐EOL within the last month of life and children with haematological cancer had an odds ratio of 11.8 (95% CI 6.1‐23.0). Conclusion The underlying diagnosis was strongly associated with HI‐EOL. Children who died from solid tumours experienced substantially less intensive treatment than both children with haematological cancer and non‐cancerous conditions did. Across non‐cancerous diagnoses, the intensity of treatment appeared consistent, which may indicate, that the awareness of palliative care is higher among oncologists than within other paediatric fields.

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Predictors for place of death among children:A systematic review and meta-analyses of recent literature

Cited by 13 publications

References 43 publications

Location of death among children with life-threatening conditions: a national population-based observational study using the Canadian Vital Statistics Database (2008–2014)

Location of death among children with life-threatening conditions: a national population-based observational study using the Canadian Vital Statistics Database (2008–2014)

Desires vs. conditions: A qualitative study exploring the factors affecting the place of death of child with cancer in Turkey

Disparities in intensity of treatment at end‐of‐life among children according to the underlying cause of death

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