Predicting place of death of patients with advanced cancer receiving home-based palliative care services in Iran.

BMC Palliat Care

Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, HezarJarib Ave, P.O. Box 319, Isfahan, Iran.

Published: September 2024

AI Article Synopsis

  • Many terminally ill cancer patients prefer to die at home, but various factors influence this preference, especially in countries with limited palliative care services like Iran.
  • A study analyzed data from 4083 advanced cancer patients to identify predictors of where they died, finding that older age and quality of homecare increased the likelihood of dying at home.
  • The results emphasize the need for better palliative care resources and informed policy decisions to support patients’ preferences for their place of death.

Article Abstract

Background: While home is frequently expressed as the favorite place of death (PoD) among terminally ill cancer patients, various factors affect the fulfillment of this wish. The determinants of the PoD of cancer patients in countries without healthcare system-integrated palliative and supportive care have not been studied before. This study aimed at identifying the predictors of the PoD of patients who suffer from advanced cancer by developing a reliable predictive model among who received home-based palliative care in Iran as a representative of the countries with isolated provision of palliative care services.

Methods: In a cross-sectional study, electronic records of 4083 advanced cancer patients enrolled in the Iranian Cancer Control Center (MACSA) palliative homecare program, who died between February 2018 and February 2020 were retrieved. Multivariable binary logistic regression analysis as well as subgroup analyses (location, sex, marital status, and tumor topography) was performed to identify the predictors of PoD.

Results: Of the 2398 cases included (mean age (SD) = 64.17 (14.45) year, 1269 (%52.9) male), 1216 (50.7%) patients died at home. Older age, presence and intensity of medical homecare in the last two weeks and registration in the Tehran site of the program were associated with dying at home (P < 0.05). Gynecological or hematological cancers, presence and intensity of the calls received from the remote palliative care unit in the last two weeks were predictors of death at the hospital (p < 0.05). The model was internally and externally validated (AUC = 0.723 (95% CI = 0.702-0.745; P < 0.001) and AUC = 0.697 (95% CI = 0.631-0.763; P < 0.001) respectively).

Conclusion: Our model highlights the demographic, illness-related and environmental determinants of the PoD in communities with patchy provision of palliative care. It also urges policymakers and service providers to identify and take the local determinant of the place of death into account to match the goals of palliative and supportive services with the patient preferences.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375916PMC
http://dx.doi.org/10.1186/s12904-024-01550-zDOI Listing

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