Abstract
BackgroundDiscrepancy between preferred and actual place of death is common in cancer patients. While previous research has elucidated the factors associated with congruence between patients' preferred and actual place of death, it is not known how the perspective of the family influences the place of death. This study examined whether family preference for place of death mediates the relationship between patient preference and actual place of death.MethodsA total of 258 cancer patients (home death, n = 142; hospital death, n = 116) who had received terminal care in Japan were analyzed. Measures included patients' demographic variables, patient and family preferences for place for death, actual place of death, patients' functional status, use and intensity of home care, availability of inpatient bed, living arrangement, and amount of extended family support.ResultsPatient-family congruence on preferred place of death was 66% in patients who died at home and 47% in patients who died at other places (kappa coefficient: 0.20 and 0.25, respectively). In a multiple logistic regression model, patients were more likely to die at home when patients were male (odds ratio [OR], 95% confidence interval [CI]: 2.53, 1.06–6.05) and when their family preferred death at home (OR, 95% CI: 37.37, 13.82–101.03). A Sobel test revealed that family preference mediated the relationship between patient preference and place of death (p<0.05).ConclusionsThis study is, to our knowledge, the first to unveil the role of the family in the relationship between patient preference and place of death in Japan. In order to honor patients' wishes to die at home, supporting caregivers in the family may be an essential component of terminal care.
Highlights
Discrepancies between preferred and actual place of death is common [1], [2]
Past research has systematically elucidated the factors associated with congruence between preferred and actual place of death, including symptom control, physician support, hospice enrollment, and family support [1]
The most important finding of the present study is how family preference for place of death mediates the relationship between patient preference and place of death
Summary
Discrepancies between preferred and actual place of death is common [1], [2]. For example, most of the terminally ill cancer patients who have indicated a preference to die at home die in hospitals [3], [4], [5], [6]. Bridging the gap between preferred and actual place of death is one essential component of terminal care for cancer patients. Another research has shown how family caregivers are more likely than patients to prefer hospitals as the place for death [4]. At present, few studies have examined how patient and family preferences for place of death interact and influence the actual place of death in a joint manner. Discrepancy between preferred and actual place of death is common in cancer patients. While previous research has elucidated the factors associated with congruence between patients’ preferred and actual place of death, it is not known how the perspective of the family influences the place of death. This study examined whether family preference for place of death mediates the relationship between patient preference and actual place of death
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