Predictors of place of death for Japanese patients with advanced-stage malignant disease in home care settings: A nationwide survey

BACKGROUND. Although the place of death for patients with advanced malignancy is influenced by multiple factors, few studies have systematically investigated the determinants of place of death. The objective of the current retrospective study was to clarify the predictors of home death throughout the duration of home palliative care for Japanese patients with advanced malignant disease. METHODS. in the current nationwide survey, the authors investigated predictors involving patient demographics and clinical profiles, the roles and status of family caregivers, and the support provided by the healthcare system in the introductory phase (during the first week of home care), the stable phase (between the introductory and dying phases), and the dying phase (during the final week before death) of home care service in Japan. RESULTS. Multivariate logistic regression models clarified that 1) patient-related clinical variables (e.g., functional status and rehospitalization); 2) the support of the healthcare system (e.g., provision of information on the dying process and visitation by home care nurses); and 3) the status and roles of family caregivers (e.g., psychologic distress levels, assistance with patient evacuation, etc.) have an effect on place of death throughout all three phases of home palliative care. Overall, the model used in the current study was able to predict 94% of home deaths accurately. CONCLUSIONS. A clearer understanding of factors that may influence place of death for patients with advanced-stage malignant disease would allow healthcare professionals to modify healthcare systems and tailor effective interventions to help patients die in their preferred location. (C) 2004 American Cancer Society.