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Place-of-death preferences among patients with cancer and family caregivers in inpatient and outpatient palliative care
  1. Marieberta Vidal1,
  2. Alfredo Rodriguez-Nunez2,
  3. David Hui1,
  4. Julio Allo1,
  5. Janet L Williams1,
  6. Minjeong Park3,
  7. Diane Liu3 and
  8. Eduardo Bruera1
  1. 1 Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Programa Medicina Paliativa y Cuidados Continuos, Pontificia Universidad Católica de Chile Facultad de Medicina, Santiago, Chile
  3. 3 Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Marieberta Vidal, Palliative Care, MD Anderson Cancer Center, Houston, TX 77030, USA; mvidal{at}mdanderson.org

Abstract

Objective Meeting the preferences of patients is considered an important palliative care outcome. Prior studies reported that more than 80% of patients with terminally ill cancer prefer to die at home. The purpose of this study was to determine place-of-death preference among palliative care patients in the outpatient centre and the palliative care unit (PCU) of a comprehensive cancer centre.

Methods A cross-sectional anonymous questionnaire was administered to patients with advanced cancer and caregivers (PCU and outpatient centre) between August 2012 and September 2014. PCU patients responded when there was no delirium and the primary caregiver responded when the patient was unable to respond. In the case of outpatients, dyads were assessed. The survey was repeated 1 month later.

Results Overall, 65% preferred home death. There was less preference for home death among PCU patients (58%) than among outpatients (72%). Patient and caregiver agreement regarding preferred place of death for home was 86%. After 1 month, outpatients were significantly more likely than PCU patients to have the same preferred place of death as they had 1 month earlier (96% vs 83%; p=0.003).

Conclusions Although home was the preferred place of death in our group of patients with advanced cancer and their caregivers, a substantial minority preferred hospital death or had no preference. We speculate that PCU patients’ higher preference for hospital death is likely related to more severe distress because they had already tried home care. Personalised assessment of place of death preference for both patient and caregiver is needed.

  • place of death
  • cancer patients
  • palliative care
  • patient preferences
  • EOL

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bmjspcare-2019-002019

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Presented at This study was presented at the 2015 Palliative Care in Oncology Symposium and the 2015 ASCO Annual Meeting.

    • Contributors Design: MV, DH, JA, JLW, MP, DL, EB. Data collection: MV, AR-N, JA, JLW, EB. Data analysis: MV, AR-N, JLW, MP, DL, EB. Draft manuscript: MV, AR-N, MP, DL, EB. Contribution and approval of final manuscript: MV, AR-N, DH, JA, JLW, MP, DL, EB.

    • Funding EB is supported in part by National Institutes of Health grants R01NR010162-01A1, R01CA122292-01 and R01CA124481-01.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.