Abstract
Understanding the preferred place of death may assist to organize and deliver palliative health care services. The study aims to assess preference for place of death among cancer patients in receipt of home-based palliative care, and to determine the variables that affect their preference for a home death. A prospective cohort design was carried out from July 2010 to August 2012. Over the course of their palliative care trajectory, a total of 303 family caregivers of cancer patients were interviewed. Multivariate regression analysis was employed to assess the determinants of a preferred home death. The majority (65%) of patients had a preference of home death. The intensity of home-based physician visits and home-based personal support worker (PSW) care promotes a preference for a home death. Married patients, patients receiving post-graduate education and patients with higher Palliative Performance Scale (PPS) scores were more likely to have a preference of home death. Patients reduced the likelihood of preferring a home death when their family caregiver had high burden. This study suggests that the majority of cancer patients have a preference of home death. Health mangers and policy makers have the potential to develop policies that facilitate those preferences.
Highlights
Following health system restructuring in Canada, more attention has been directed towards home-based palliative care
Gu et al conducted a multivariable logistic regression analysis and found that cancer patients living in rural areas in China, living with their relatives, and of lower educational attainment were more likely to prefer to die at home [8]
Our results showed that an increase in the intensity of home-based palliative physician visits and personal support workers (PSW) hours increased the likelihood of patients reporting a preference for a home death
Summary
Following health system restructuring in Canada, more attention has been directed towards home-based palliative care. Care components primarily comprise home-based physician visits, nursing visits and hours of care from personal support workers (PSW) [1]. Home-based palliative care enables patients who are terminally ill to be cared for at home and aims to improve their quality of life [2]. A better understanding of the determinants of preference for place of death may assist to actualize those preferences, while achieving a preferred place of death is considered an indicator of high-quality end-of-life care [5,6]. Recognizing individual preference for the place of death can improve the quality of end-of-life care and help to provide support for them [7]
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