title: Factors associated with location of death of children with cancer in palliative care.
abstract: OBJECTIVE
  The aim of this study was to identify factors associated with location of death of patients receiving palliative care in a pediatric oncology unit.
  
  
  METHODS
  A palliative care program was developed in the pediatric department in order to provide specialized attention to the patient and family in end-of-life. The program is coordinated by a nurse, delivering a simultaneous interdisciplinary team approach with focus on identification and training of a family care provider as well as local resources supplemented by support of a social worker and the community. All 87 patients in palliative care were followed by the team. The factors associated with the location of death (home or hospital) were evaluated for the 71 patients who died prior to analysis.
  
  
  RESULTS
  Forty-two (59%) patients died at home. Factors significantly associated with dying at home were: male with an Odds Ratio (OR) = 3.80, 95% Confidence Interval (CI) = 1.26-11.76; public health insurance (OR) = 4.95, 95%[CI] = 1.03-26.75, low educational level of the caregiver (OR) = 11.11 95%[CI] = 1.65-94.66 and low educational level of the mother (OR) = 7.07 95%[CI] = 1.37-40.14. Gender was the only independent factor associated with location of death: a boy had a higher risk of dying at home, (OR) = 4.25, 95%[CI] = 1.37-13.21 when compared to a girl.
  
  
  CONCLUSIONS
  In our society we are still not able to provide hospice care or home care for all children, although increasing emphasis has been placed on utilizing local resources. Even though we had increased the number of desired home deaths, it is still a challenge to meet patients and families' requests. A team approach, the recognition of the factors involved, and adequate health and community support have helped us to meet the child and family's needs.
authors.affiliation: Pediatric Department, Centro de Tratamento e Pesquisa, Hospital A C Camargo-Hospital do Câncer, São Paulo, Brazil. aykurash@uol.com.br
authors.forename: Andréa Yamaguchi
authors.initials: AY
authors.lastname: Kurashima
authors.forename: Maria Do Rosário Dias
authors.initials: Mdo R
authors.lastname: Latorre
authors.forename: Silvia Aparecida De Paiva
authors.initials: SA
authors.lastname: Teixeira
authors.forename: Beatriz
authors.initials: B
authors.lastname: De Camargo
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006701:Home Nursing; D006760:Hospitalization; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms; D010166:Palliative Care; D011446:Prospective Studies; D013727:Terminal Care