Identification of Topics Explained by Home Doctors to Family Caregivers with Cancer Patients Died at Home: A Quantitative Text Analysis of Actual Speech in All Visits.

Abstract

An important consideration in the quality of end-of-life care is whether the patient's place of death matches his or her hopes. We aimed to identify topics related to patients' home death by comparing the occurrence frequency of topics explained by doctors for family caregivers between the home death cases and the hospital death cases. The method of integrating qualitative and quantitative data was adopted in this study. Primary participants were 24 home doctors who specialized home medical care. Enrolled 18 patients received periodical medical care by cooperated doctors, understood their own health situation, and lived with family caregivers. Doctors recorded all their speech during every visit with voice-recorder until the patient died at home or was re-hospitalized. Doctors' speech was transcribed and converted to the number of occurrences based on number of visits. The occurrence frequency was compared with a χ2 test (Yates' correction). Speaking records of 227 visits to 18 patients by doctors were collected. Finally, 16 patients died at home and two died at hospital. We measured the occurrence frequency of topics during maximum 26 visits on 16 home death cases and maximum 13 visits on two hospital death cases. The topics of patients' death, helping daily burden using public insurance, and financial application were more frequently appeared with home death cases than hospital death cases. In conclusion, doctors should explain to family caregivers the topics of patients' death process and specific measures or procedures for reduction in care burden.