Population-based study of place of death of patients with cancer: implications for GPs.
BACKGROUND
A majority of patients with cancer who are seriously ill have a preference of dying at home. However, only a minority of patients actually die at home in most Western countries.


OBJECTIVE
To explore factors associated with place of death in an unselected population of patients with cancer.


METHODS
Case-control study.


METHODS
County of Funen, Denmark.


METHODS
Register linkage from six Danish healthcare registers.


RESULTS
The GP's home visit during the last 3 months before death was inversely associated with dying in hospital (adjusted odds ratio [OR] = 0.08, 95% confidence interval [CI] = 0.06 to 0.12) and so were community nurses visiting the home (OR = 0.36, 95% CI = 0.26 to 0.48). Furthermore, being married (OR = 0.68, 95% CI = 0.56 to 0.85), and age at death of 40-65 years (OR = 0.70, 95% CI = 0.56 to 0.90) seemed to have an effect. Hospital death was associated with survival time of less than 1 month (OR = 2.27, 95% CI = 1.69 to 3.13). Type of cancer, sex, or residence (urban versus rural) were not associated with a hospital death in this multivariate analysis.


CONCLUSIONS
Dying at home was, to a higher extent, associated with GP visit and, to a lesser extent, community nurse visit than with clinical and sociodemographic characteristics of patients with cancer. In our view, these findings indicate the importance of the GP in particular. To increase the opportunity to die at home, more research is needed on the role of the GP and the interface between GPs and other providers of health care at home for patients who are terminally ill with cancer.
Aabom
Birgit
B
Institute of Public Health, University of Southern Denmark, Odense, Denmark. baabom@health.sdu.dk
Kragstrup
Jakob
J
Vondeling
Hindrik
H
Bakketeig
Leiv S
LS
Støvring
Henrik
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D001293:Attitude to Death; D016022:Case-Control Studies; D003718:Denmark / Q000453:epidemiology; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D017052:Hospital Mortality; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality*; D010166:Palliative Care / Q000379:methods; D017060:Patient Satisfaction; D013727:Terminal Care / Q000379:methods; D019452:Terminally Ill / Q000706:statistics & numerical data