Dataset Information

A retrospective analysis of factors associated with selection of end-of-life care and actual place of death for patients with cancer.

ABSTRACT:

Objectives

The factors associated with end-of-life (EOL) care that patients with cancer selected and actual place of death (POD) is less elucidated. We analysed how specific EOL care, especially anticancer therapies, selected by patients with pancreatic carcinoma affected their POD in Japan.

Setting

A retrospective cohort study using clinical records of a single institute.

Participants

This study included 433 advanced or recurrent patients with pancreatic carcinoma who had completed standard chemotherapies and were receiving hospice care in the National Cancer Center Hospital between April 2008 and April 2011.

Outcome measures

We analysed statistical association factors, demographic information, geographical differences, medical environment, EOL care selection, along with actual POD using logistic regression analysis.

Results

Of the 433 patients, 147 selected palliative care units (PCUs) as the POD; 229, hospital; and 57, home with hospice care. POD selection was associated with several factors. Notably, EOL care selection, especially the use of complementary and alternative medicine (CAM), is associated with POD selection (death in PCU; OR=0.23, p=0.02).

Conclusions

This study is, to the best of our knowledge, the first to unveil that EOL care selection is associated with POD in Japan. Certain factors such as gender, medical environment and EOL care selection might influence the POD. Patients who pursue aggressive anticancer therapies, such as CAM use, were possibly deprived of a chance of early reference to a PCU.

SUBMITTER: Kondo S

PROVIDER: S-EPMC4024592 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Publications

A retrospective analysis of factors associated with selection of end-of-life care and actual place of death for patients with cancer.

Kondo Shunsuke S Shimazu Taichi T Morizane Chigusa C Hosoi Hiroko H Okusaka Takuji T Ueno Hideki H

BMJ open 20140502 5

<h4>Objectives</h4>The factors associated with end-of-life (EOL) care that patients with cancer selected and actual place of death (POD) is less elucidated. We analysed how specific EOL care, especially anticancer therapies, selected by patients with pancreatic carcinoma affected their POD in Japan.<h4>Setting</h4>A retrospective cohort study using clinical records of a single institute.<h4>Participants</h4>This study included 433 advanced or recurrent patients with pancreatic carcinoma who had ...[more]

PMID: 24793245

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Project description:BACKGROUND:Many older people wish to die at home. However, there is still a huge gap between the place where older adults wish to die and the place where they, in fact, do die. We aimed to assess the association between each type of long-term care (LTC) services that home-dwelling older individuals utilized at their end of life and place of death. METHODS:A pooled cross-sectional study at the point of death was used for the analysis. Participants included beneficiaries of long-term care insurance in Japan, aged 65?years and above, who passed away between January 2008 and December 2013, excluding those who died due to external factors and those who were using residential services at their time of death. We conducted a multivariate Poisson regression analysis with robust standard errors adjusting for potential confounders and examined the association between the use of each type of LTC service for home-dwelling recipients, including in-home services, day services, and short-stay services, with the interaction terms being time of death (exposure) and home death (outcome). We calculated the adjusted probability of home deaths for each combination pattern of LTC services for home-dwelling recipients using standard marginalization. RESULTS:We analyzed 2,035,657 beneficiaries. The use of in-home services, day services, and short-stay services were associated with an increased probability of home deaths; the incident rate ratio (IRR) was 13.40 (with a 95% confidence interval (CI): 13.23-13.57) for in-home services, the IRR was 6.32 (6.19-6.45) for day services, and the IRR was 1.25 (1.16-1.34) for short-stay services. Those who used day or short-stay services with in-home services exhibited a higher probability of home deaths than those who used only day or short-stay services. CONCLUSIONS:We demonstrated that home-dwelling older persons who used LTC services near end-of-life had a higher probability of home deaths as compared to those who did not. Our findings can clarify the importance of providing and integrating such services to support care recipients who wish to die at home as well as for the benefit of their informal caregivers.

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Dataset Information

A retrospective analysis of factors associated with selection of end-of-life care and actual place of death for patients with cancer.

Objectives

Setting

Participants

Outcome measures

Results

Conclusions

Publications

A retrospective analysis of factors associated with selection of end-of-life care and actual place of death for patients with cancer.

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