1455P Clinical factors influencing place of death of oncology patients in palliative care in a primary care district of Cadiz

Abstract

Death at home is an increasingly more common measure for improving the quality of palliative care services. The study analyzes the factors that may influence the place of death of oncology patients in palliative care (hospital/home), focusing on clinical characteristics. Study design: longitudinal, prospective single-cohort, analytical. 427 people were studied in 2018 in the Bahia de Cadiz-La Janda District (Andalusia, Spain). Data were collected during initial evaluation, follow-up, Last Days and Hours of Life (LDHL) and after death. Among the data gathered: place of death, Palliative Performance Scale (PPS), Palliative Care Complexity Index (IDC-Pal), Charlson Comorbidity Index (CCI), hospital admissions, advanced treatments and symptoms during follow-up and LDHL. 52.2% of patients died at home and 47.8% died in the hospital. Among the individuals who died at home, the results reveal: - A less complex situation (IDC-Pal) throughout the entire process (60.9%, 84.1% and 88.4%; p<0.02 in all these cases). - Less prognosis of survival at initial evaluation (PPS) (57.2 vs 52.4; p=0.003). - Absence of hospital admissions (26.8% vs 78.6%; p<0.001) or a lower number of admissions (0.32 vs 1.12; p<0.001). - Absence of toxicity to opioids (p=0.05), as well as lower pain intensity during LDHL (3.45 vs 4.31; p=0.01), dyspnea (2.94 vs 3.89; p=0.009), nausea/vomiting (1.31 vs 1.72; p=0.031) and anxiety (4.31 vs 5.10; p=0.030). No significant differences were found in place of death (home/hospital) according to age, sex, advanced complementary treatment and other symptoms/complications studied. The main clinical characteristics that have been found to influence the place of death are: case complexity, survival prognosis, hospital admissions and number of admissions during the process, toxicity to opioids, and intensity of certain symptoms in LDHL, such as: pain, dyspnea, nausea/vomiting and anxiety. It is essential to conduct a thorough evaluation of this type of patient and process, but it may prove especially important to prioritize the aspects herein identified.