Abstract
Five palliative home care teams participated in a prospective Swedish study that included 221 palliative cancer patients. All patients with incurable malignant disease that were admitted and died during 1999 were included. On admission, demographic data were recorded. When patients, despite ongoing home care, were referred to institutional care, doctors and nurses involved were interviewed about the reasons for this. After the patients' death next of kin involved in the care were interviewed according to a questionnaire. Approximately half of the patients died at home. The reasons for referral showed a wide diversity and included both social and psychosocial factors, medical emergencies and problems related to symptom control. A preference for dying at home and not living alone were shown to be the strongest predictors of home death (p=0.001). However, 35% of patients living alone died at home. Interestingly enough, Karnofsky performance index (KPI) at admission was significantly lower for those dying at home, despite similar mean time of care. The understanding of impending death was significantly more common among the families of those patients dying at home.
Similar content being viewed by others
References
Antonovsky A (1987) Unravelling the mystery of health: How people manage stress and stay well. Jossey-Bass, San Fransisco
Axelsson B, Christensen SB (1996)Place of death correlated to sociodemographic factors. A study of 203 patients dying of cancer in a rural Swedish county in 1990. Palliat Med 10(4):329–335
Beck-Friis B, Strang P (1993) The organization of hospital-based home care for terminally ill cancer patients: the Motala model. Palliat Med 7(2):93–100
Brazil K, Bedard M, Willison K (2002) Factors associated with home death for individuals who receive home support services: a retrospective cohort study. BMC Palliat Care 1(1):2
Cantwell P, Turco S, Brenneis C, Hanson J, Neumann CM, Bruera E (2000) Predictors of home death in palliative care cancer patients. J Palliat Care 16(1):23–28
Costantini M, Camoirano E, Madeddu L, Bruzzi P, Verganelli E, Henriquet F (1993) Palliative home care and place of death among cancer patients: a population-based study. Palliat Med 7(4):323–331
De Conno F, Caraceni A, Groff L, Brunelli C, Donati I, Tamburini M, Ventafridda V (1996) Effect of home care on the place of death of advanced cancer patients. Eur J Cancer 32A(7):1142–1147
Dunlop R, Hockley J, Davies R (1989) Preferred versus actual place of death. A hospital terminal care support team experience. Palliati Med 3:197–201
Gilbar O, Steiner M (1996) When death comes: where should patients die? Hosp J (11)31–48
Grande GE, Addington-Hall JM, Todd CJ (1998) Place of death and access to home care services: are certain patient groups at a disadvantage? Soc Sci Med 47(5):565–579
Higginson IJ, Astin P, Dolan S (1998) Where do cancer patients die? Ten-year trends in the place of death of cancer patients in England. Palliat Med 12(5):353–363
Higginson IJ, Jarman B, Astin P, Dolan S (1999). Do social factors affect where patients die: an analysis of 10 years of cancer deaths in England. J Public Health Med 21(1):22–28
Hinton J (1994) Can home care maintain an acceptable quality of life for patients with terminal cancer and their relatives? Palliat Med 8(3):183–196
Hinton J (1994) Which patients with terminal cancer are admitted from home care? Palliat Med 8(3):197–210
Jordhoy MS, Fayers P, Saltnes T, Ahlner-Elmqvist M, Jannert M, Kaasa S (2000) A palliative-care intervention and death at home: a cluster randomised trial. Lancet 356(9233):888–93
Karlsen S, Addington-Hall J (1998) How do cancer patients who die at home differ from those who die elsewhere? Palliat Med 12(4):279–286
Landstingsförbundet (1998) Hemsjukvård—en annan dimension (Swe) Stockholm: Landstingsförbundet
McWhinney IR, Bass MJ, Orr V (1995) Factors associated with location of death (home or hospital) of patients referred to a palliative care team. Cmaj 152(3):361–367
Mercadante S, Casuccio A, Fulfaro F (2000) The course of symptom frequency and intensity in advanced cancer patients followed at home. J Pain Symptom Manage 20(2):104–112
Milberg A, Strang P (2000) Met and unmet needs in hospital-based home care: qualitative evaluation through open-ended questions. Palliat Med 14(6):533–534
Rosenquist A, Bergman K, Strang P (1999) Optimizing hospital-based home care for dying cancer patients: a population-based study. Palliat Med 13(5):393–397
SBU (1999) Avancerad hemsjukvård och hemrehabilitering. SBU rapport 146 (Swe.). Stockholm: SBU
Strang S, Strang P (2001) Spiritual thoughts, coping and 'sense of coherence' in brain tumour patients and their spouses. Palliat Med 15(2):127–134
Thoren-Todoulos E (1999) [Psychosocial factors are limiting the possibility of dying at home]. Lakartidningen 96(5):472–475
Townsend J, Frank AO, Fermont D, Dyer S, Karran O, Walgrove A, Piper M (1990) Terminal cancer care and patients' preference for place of death: a prospective study. Bmj 301(6749):415–417
Van den Eynden B, Hermann I, Schrijvers D, Van Royen P, Maes R, Vermeulen L, Herweyers K, Smits W, Verhoeven A, Clara R, Denekens J (2000) Factors determining the place of palliative care and death of cancer patients. Support Care Cancer 8(1):59–64
Acknowledgements
Stockholm County Council is acknowledged for generous financial support, and Per Nasman, Centre for Safety Research, Royal Institute of Technology, Stockholm, for help with statistics.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gyllenhammar, E., Thoren-Todoulos, E., Strang, P. et al. Predictive factors for home deaths among cancer patients in Swedish palliative home care. Support Care Cancer 11, 560–567 (2003). https://doi.org/10.1007/s00520-003-0487-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-003-0487-z