The interaction of socioeconomic status with place of death: a qualitative analysis of physician experiences

Wales, Joshua; Kurahashi, Allison; Husain, Amna

doi:10.1186/s12904-018-0341-1

Cited by 24 publications

(17 citation statements)

References 57 publications

(67 reference statements)

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“…The suggestion that availability of social support is the main socioeconomic factor determining place of death has been recognised elsewhere. [37][38][39] The evidence in this review supports the wider literature that suggests preferred place of death is usually, but not always, at home. However, within this broad preference, this study has also shown support for work by Gomes 40 that found preference for home care substantially decreased in the final few weeks of life, supporting Pollock's 41 view that home may not always be the best place to die.…”

Section: What This Study Addssupporting

confidence: 79%

Socioeconomic factors affecting access to preferred place of death: A qualitative evidence synthesis

Turner

Flemming

2019

Palliat Med

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Background: Existing quantitative evidence suggests that at a population level, socioeconomic factors affect access to preferred place of death. However, the influence of individual and contextual socioeconomic factors on preferred place of death are less well understood. Aim: To systematically synthesise the existing qualitative evidence for socioeconomic factors affecting access to preferred place of death in the United Kingdom. Design: A thematic synthesis of qualitative research. Data sources: Cochrane Library, MEDLINE, Embase, CINAHL, ASSIA, Scopus and PsycINFO databases were searched from inception to May 2018. Results: A total of 13 articles, reporting on 12 studies, were included in the synthesis. Two overarching themes were identified: ‘Human factors’ representing support networks, interactions between people and decision-making and ‘Environmental factors’, which included issues around locations and resources. Few studies directly referenced socioeconomic deprivation. The main factor affecting access to preferred place of death was social support; people with fewer informal carers were less likely to die in their preferred location. Other key findings included fluidity around the concept of home and variability in preferred place of death itself, particularly in response to crises. Conclusion: There is limited UK-based qualitative research on socioeconomic factors affecting preferred place of death. Further qualitative research is needed to explore the barriers and facilitators of access to preferred place of death in socioeconomically deprived UK communities. In practice, there needs to be more widespread discussion and documentation of preferred place of death while also recognising these preferences may change as death nears or in times of crisis.

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Section: What This Study Addssupporting

confidence: 79%

Socioeconomic factors affecting access to preferred place of death: A qualitative evidence synthesis

Turner

Flemming

2019

Palliat Med

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“…The correlation found between dying at home and socioeconomic status has been previously reported in other countries [8]. The mechanisms whereby socioeconomic status affects one's ability to die at home may involve various factors: the ability to provide adequate care at home, adequate access to care services, care-related costs, control over monetary resources, the ability to secure local support, and personal preferences [9]. Socioeconomic status may, however, in uence or be in uenced by other dominant variables.…”

Section: Discussionsupporting

confidence: 66%

Predictors of Death at Home Among Cancer Patients in Israel: A Population-based Study

Rottenberg

Goldzweig

Shaulov

2020

Preprint

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Background: Most cancer patients want to die at home; however, many die in hospital. The aim of the current study is to elucidate the correlation between dying at home and various personal factors in the Israeli population of cancer patients.Methods: Data on cancer incidence (2008-2015) and death (2008-2017) was provided by the Israeli Central Bureau of Statistics and the Israel National Cancer Registry. Binary logistic regression analyses were performed to assess odds ratios for death at home following cancer diagnosis while controlling for age, sex, ethnicity, years of education, residential socioeconomic score, and time from diagnosis. We also assessed the relation between place of death and specific cancer sites, as well as the time trend from 2008-2017.Results: About one quarter (26.7%) of the study population died at home. Death at home was most frequent among patients diagnosed with brain tumors (37.0%), while it was the lowest among patients with hematologic malignancies (lymphoma and leukemia, 20.3% and 20.0%, respectively). Rates of dying at home among patients with residential socioeconomic scores of 1, 2-9, and 10 were about 15%, 30%, and 42.9%, respectively. In patients from the 4th to the 7th decades of life, rates of death at home increased at a linear rate that increased exponentially from the 8th decade onwards. After controlling for potential confounders, predictive variables for death at home included age (HR=1.020 per year), male sex (HR=1.18), years of education (HR=1.029 per year), and time from diagnosis (HR=1.003 per month, all p<0.001). No trend was seen from 2008-2013, while from 2014-2017 a slight increase in the rate of death at home was seen each year.Conclusions: These results indicate that inequality exists among cancer patients in Israel regarding the opportunity to die at home. The present findings stress the importance of delivering efficient palliative care at home, mainly for patients with hematologic malignancies, younger patients, and patients of very low socioeconomic statuses. Understanding the complex mechanisms whereby patient preferences and the above variables may determine the preferred place of death remains an important research priority.

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“…The association found between dying at home and socioeconomic status has been previously reported in other countries [8]. The mechanisms whereby socioeconomic status affects one's ability to die at home may involve various factors: whether a person lives alone, the ability to provide adequate care at home, adequate access to care services, care-related costs, control over monetary resources, the ability to secure local support, and personal preferences [9]. Socioeconomic status may, however, in uence or be in uenced by other dominant variables.…”

Section: Discussionsupporting

confidence: 56%

Predictors of death at home among cancer patients in Israel: A population-based study

Rottenberg

Goldzweig

Shaulov

2021

Preprint

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Background: Most cancer patients prefer to die at home; however, many die in hospital. The aim of the current study is to elucidate the association between dying at home and various personal factors in the Israeli population of cancer patients.Methods: Data on cancer incidence (2008-2015) and death (2008-2017) was provided by the Israeli Central Bureau of Statistics and the Israel National Cancer Registry. Binary logistic regression analyses were performed to assess odds ratios for death at home following cancer diagnosis while controlling for age, sex, ethnicity, years of education, residential socioeconomic score, and time from diagnosis. We also assessed the relation between place of death and specific cancer sites, as well as the time trend from 2008-2017.Results: About one quarter (26.7%) of the study population died at home. Death at home was most frequent among patients diagnosed with brain tumors (37.0%), while it was the lowest among patients with hematologic malignancies (lymphoma and leukemia, 20.3% and 20.0%, respectively). Rates of dying at home among patients with residential socioeconomic scores of 1, 2-9, and 10 were about 15%, 30%, and 42.9%, respectively. In patients from the 4th to the 7th decades of life, rates of death at home increased at a linear rate that increased exponentially from the 8th decade onwards. After controlling for potential confounders, predictive variables for death at home included age (OR=1.020 per year, 95% CI 1.017-1.024), male sex (OR=1.18, , 95% CI 1.077-1.294), years of education (OR=1.029 per year, 95% CI 1.018-1.040), and time from diagnosis (OR=1.003 per month, 95% CI 1.001-1.005 all p<0.001). No trend was seen from 2008-2013, while from 2014-2017 a slight increase in the rate of death at home was seen each year.Conclusions: These results indicate wide variability in death at home exists among patients of different ages, sex, education, socioeconomic status and time from diagnosis. These findings stress the importance of delivering quality palliative care at home, mainly for patients with hematologic malignancies, younger patients, and patients of very low socioeconomic status. Understanding the complex mechanisms whereby patient preferences and the above variables may determine the preferred place of death remains an important research priority.

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The interaction of socioeconomic status with place of death: a qualitative analysis of physician experiences

Cited by 24 publications

References 57 publications

Socioeconomic factors affecting access to preferred place of death: A qualitative evidence synthesis

Socioeconomic factors affecting access to preferred place of death: A qualitative evidence synthesis

Predictors of Death at Home Among Cancer Patients in Israel: A Population-based Study

Predictors of death at home among cancer patients in Israel: A population-based study

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