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Death at home: predictive factors in a medical home care unit
  1. Martina Rasch-Westin1,
  2. Maria Helde-Frankling1 and
  3. Linda Björkhem-Bergman1,2
  1. 1 Advanced Medical Home Care and Hospice Ward, ASIH Stockholm Södra, Älvsjö, Sweden
  2. 2 Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
  1. Correspondence to Dr Linda Björkhem-Bergman, Palliative Home Care and Hospice Ward, ASIH Stockholm Södra, Älvsjö 12559, Sweden; linda.bjorkhem-bergman{at}ki.se

Abstract

Objectives The aim of this study was to investigate factors predictive for ‘death at home’ for patients admitted to an advanced medical home care unit in Stockholm, Sweden, with a focus on possible gender differences. In addition, place of death in relation to the patient’s wishes was studied.

Method A retrospective review of medical records of all 456 deceased patients, 233 men and 223 women, admitted to the unit during 2017 was performed. Data on age, diagnosis, living conditions, Swedish language skills, desired place of death (if stated) and place of death were retrieved from the patients’ charts.

Results A total of 114 of 456 patients died at home (25%). The probability of ‘death at home’ was independent of gender, age, diagnosis, living conditions and Swedish language skills. In a binary logistic regression model, the only factor significantly associated with death at home was ‘the wish to die at home’ (p<0.001). In the study population, 154 patients (34%) had expressed a preferred place of death, 116 (75%) wanted to die at home and 38 (25%) wanted to die in hospice. Of all patients who expressed a preferred place of death, 80% (n=123) had their wishes fulfilled and there were no differences between the sexes.

Conclusion This study indicates equal opportunities regarding the possibility to die at home for patients admitted to advanced medical home care. It emphasises the importance of asking patients where they want to be at the end of life, as it was the foremost prognostic factor for place of death.

  • palliative care
  • terminal care
  • home care
  • end of life care
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Footnotes

  • Contributors MR-W and LB-B designed the study. MR-W collected the data. MR-W, MH-F and LB-B analysed and interpreted the data. MR-W and LBB wrote the first draft of the manuscript. MR-W, MH-F and LB-B contributed and approved the final version of the manuscript.

  • Funding This study was financially supported by grants from the Stockholm County Council (ALF 20160036 and ALF 20180320), the Swedish Cancer Society (CAN 2017/233 and CAN 2018/316) and the Stockholms Sjukhems Jubileumsfond.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The review of the medical records was approved by the Regional Ethical Committee in Stockholm, Dnr 2018/1798-31.

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

  • Data availability statement The raw data are available from the corresponding author on request.

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