A Prospective Cohort Study of Factors Associated With Place of Death Among Patients With Late-Stage Cancer in Southern Africa

Abstract

ContextIdentifying factors that affect terminally ill patients' preferences for and actual place of death may assist patients to die wherever they wish. ObjectiveThe objective of this study was to investigate factors associated with preferred and actual place of death for cancer patients in Johannesburg, South Africa. MethodsIn a prospective cohort study at a tertiary hospital in Johannesburg, South Africa, adult patients with advanced cancer and their caregivers were enrolled from 2016 to 2018. Study nurses interviewed the patients at enrollment and conducted postmortem interviews with the caregivers. ResultsOf 324 patients enrolled, 191 died during follow-up. Preferred place of death was home for 127 (66.4%) and a facility for 64 (33.5%) patients; 91 (47.6%) patients died in their preferred setting, with a kappa value of congruence of 0.016 (95% CI = −0.107, 0.139). Factors associated with congruence were increasing age (odds ratio [OR]: 1.03, 95% CI: 1.00–1.05), use of morphine (OR: 1.87, 95% CI: 1.04–3.36), and wanting to die at home (OR: 0.44, 95% CI: 0.24–0.82). Dying at home was associated with increasing age (OR 1.03, 95% CI 1.00–1.05) and with the patient wishing to have family and/or friends present at death (OR 6.73, 95% CI 2.97–15.30). ConclusionMost patients preferred to die at home, but most died in hospital and fewer than half died in their preferred setting. Further research on modifiable factors, such as effective communication, access to palliative care and morphine, may ensure that more cancer patients in South Africa die wherever they wish.