Predictors of place of death for Japanese patients with advanced‐stage malignant disease in home care settings: A nationwide survey

Abstract

BACKGROUNDAlthough the place of death for patients with advanced malignancy is influenced by multiple factors, few studies have systematically investigated the determinants of place of death. The objective of the current retrospective study was to clarify the predictors of home death throughout the duration of home palliative care for Japanese patients with advanced malignant disease.METHODSIn the current nationwide survey, the authors investigated predictors involving patient demographics and clinical profiles, the roles and status of family caregivers, and the support provided by the healthcare system in the introductory phase (during the first week of home care), the stable phase (between the introductory and dying phases), and the dying phase (during the final week before death) of home care service in Japan.RESULTSMultivariate logistic regression models clarified that 1) patient‐related clinical variables (e.g., functional status and rehospitalization); 2) the support of the healthcare system (e.g., provision of information on the dying process and visitation by home care nurses); and 3) the status and roles of family caregivers (e.g., psychologic distress levels, assistance with patient evacuation, etc.) have an effect on place of death throughout all three phases of home palliative care. Overall, the model used in the current study was able to predict 94% of home deaths accurately.CONCLUSIONSA clearer understanding of factors that may influence place of death for patients with advanced‐stage malignant disease would allow healthcare professionals to modify healthcare systems and tailor effective interventions to help patients die in their preferred location. Cancer 2004. © 2004 American Cancer Society.

A population-based study on the specific locations of cancer deaths in Taiwan, 1997–2003

“…The rate found in this study is also similar to the results reported by Fukui et al [10] who found that among a sample of 428 Japanese patients receiving palliative care at home, 64.8% subsequently died in their own homes.…”

Associations between home death and GP involvement in palliative cancer care

“…6,7,9 Since addressing this important association was not an aim of this study and the finding came from an adjustment in the analysis of community nurses' involvement, no conclusion can be made and the found association therefore deserves further investigation.…”

“…5 However, studies indicate that GP involvement is associated with facilitating home death. [6][7][8][9] Furthermore, despite earlier studies identifying considerable dissatisfaction with symptom control in a primary care setting, 3,10 satisfaction with GPs was still rated high 3 and relatives valued the involvement of GPs. 11,12 All in all, it suggests that good palliative care amounts to more than simply a certain degree of symptom control.…”

Knowledge, beliefs, and concerns about opioids, palliative care, and homecare of advanced cancer patients: a nationwide survey in Japan

“…Negative beliefs about palliative care were also one of the significant determinants of the potential underuse of specialized palliative care services [8][9][10][11][12]. Moreover, many patients have concerns and difficulties about homecare, such as the burden on the family, concerns about sudden changes in physical conditions, and the unavailability of physicians visiting their home, and these could influence patients' decisions regarding whether or not to receive homecare [13][14][15][16][17][18][19].…”

“…Among them, multiple empirical studies have identified knowledge, beliefs, or concerns about opioids, palliative care, and homecare in the general population and cancer patients as potential barriers for quality palliative care [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Many surveys have shown that incorrect knowledge about cancer pain and opioids could interfere with optimal pain management, especially an unrealistic fear of addiction and life-shortening [2][3][4][5][6][7].…”