Propensity for Home Death Among Taiwanese Cancer Decedents in 2001–2006, Determined by Services Received at End of Life

• Published in: Journal of pain and symptom management 2010-10, Vol.40 (4), p.566-574
• Main Authors: Tang, Siew Tzuh, DNSc, Huang, Ean-Wen, PhD, Liu, Tsang-Wu, MD, Rau, Kun-Ming, MD, Hung, Yen-Ni, PhD, Wu, Shiao-Chi, PhD
• Format: Article
• Language: English
• Subjects: administrative database analysis; Anesthesia & Perioperative Care; Attitude to Death; Biological and medical sciences; Cancer; Databases, Factual; Death; Dying; End of life decisions; end-of-life care; Female; home death; Hospice Care - organization & administration; Hospice Care - psychology; Hospitals; Humans; Male; Medical sciences; Neoplasms - psychology; Pain Medicine; Pharmacology. Drug treatments; Place of death; population-based study; Retrospective Studies; Taiwan; Terminal Care - organization & administration; Terminal Care - psychology; terminally ill cancer patients
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2010.01.020

Abstract Context The discrepancy between patients’ preferred and actual place of death highlights the dilemma inherent in achieving their preferences for home death. Research on determinants of home death has been limited largely by focusing on individual-level factors and somewhat on health care resources at the primary hospital and regional levels. Objectives To investigate factors associated with home death, specifically, services received by cancer patients at the end of life (EOL). Methods This was a retrospective cohort study using administrative data from 201,201 Taiwanese cancer decedents in the period 2001–2006. Results Rates of home death decreased significantly over time (from 35.67% to 32.39%). Dying at home was associated with patient demographics (gender, age, and marital status) and disease characteristics (cancer type, metastatic status, postdiagnosis survival time, and comorbidity level). Taiwanese cancer patients were less likely to die at home if they received care from a medical oncologist and in hospitals or regions with abundant health care resources. Furthermore, Taiwanese cancer patients were less likely to die at home if they used life-sustaining treatments (intensive care unit care, cardiopulmonary resuscitation, intubation, and mechanical ventilation) in the last month of life. However, multiple emergency room visits in the last month of life and receiving hospice care increased Taiwanese cancer patients’ propensity to die at home. Conclusion Despite the causal ambiguity in interpreting our research findings, they indicate that using life-sustaining treatments at EOL not only exacts a substantial toll from patients, family members, and society, but also decreases the likelihood of dying at home.