title: Does dying at home influence the good death of terminal cancer patients?
abstract: To investigate whether dying at home influences the likelihood that a terminal cancer patient will achieve a good death despite the limited medical resources available in many communities, this study investigated the relationship between the achievement of a good death and the performance of good-death services in two groups with different places of death, and explored the possible factors associated with this relationship. Three hundred and seventy-four consecutive patients with terminal cancers admitted to a palliative care unit were enrolled. Two instruments, the good-death scale and the audit scale for good-death services, were used in the study. Mean age of the 374 patients was 65.45 +/- 14.77 years. The total good-death score in the home-death group (n=307) was significantly higher than that in the hospital-death group (n=67), both at the time of admission (t= -5.741, P<0.001) and prior to death (t= -3.027, P<0.01). However, the score of item "degree of physical comfort" assessed prior to death in the home-death group was lower than that in the hospital-death group (P=0.185). As to the audit scale for good-death services, each subscale score and total scores in the home-death group were significantly higher than that in the hospital-death group, with the exception of the subscale "continuity of social support" (4.72 vs. 4.61, P=0.132). Bereavement support (odds ratio=1.01, 95% confidence interval=0.62-1.39; multiple regression), alleviation of anxiety (0.81, 0.46-1.15), decision-making participation (0.61, 0.26-0.95), fulfillment of last wish (0.45, 0.08-0.82), and survival time (0.00, 0.00-0.01) were independent correlates of the good-death score (35.8% of explained variance). However, the place of death was not in the model. The study conclusively suggests the necessity for palliative home care to strengthen the competence of physical care. Moreover, earlier incorporation of palliative care into anticancer therapies can lead to better death preparation and good-death services, and thus be helpful to achieve a good death.
authors.affiliation: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Chien-An
authors.initials: CA
authors.lastname: Yao
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Hu
authors.forename: Yun-Fong
authors.initials: YF
authors.lastname: Lai
authors.forename: Shao-Yi
authors.initials: SY
authors.lastname: Cheng
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D001293:Attitude to Death; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011795:Surveys and Questionnaires; D013624:Taiwan; D013727:Terminal Care / Q000523:psychology* / Q000706:statistics & numerical data