Which hospice patients with cancer are able to die in the setting of their choice? Results of a retrospective cohort study.
OBJECTIVE
To determine which hospice patients with cancer prefer to die at home and to define factors associated with an increased likelihood of dying at home.


METHODS
An electronic health record-based retrospective cohort study was conducted in three hospice programs in Florida, Pennsylvania, and Wisconsin. Main measures included preferred versus actual site of death.


RESULTS
Of 7,391 patients, preferences regarding place of death were determined at admission for 5,837 (79%). After adjusting for other characteristics, patients who preferred to die at home were more likely to die at home (adjusted proportions, 56.5% v 37.0%; odds ratio [OR], 2.21; 95% CI, 1.77 to 2.76). Among those patients (n = 3,152) who preferred to die at home, in a multivariable logistic regression model, patients were more likely to die at home if they had at least one visit per day in the first 4 days of hospice care (adjusted proportions, 61% v 54%; OR, 1.23; 95% CI, 1.07 to 1.41), if they were married (63% v 54%; OR, 1.35; 95% CI, 1.10 to 1.44), and if they had an advance directive (65% v 50%; OR, 2.11; 95% CI, 1.54 to 2.65). Patients with moderate or severe pain were less likely to die at home (OR, 0.56; 95% CI, 0.45 to 0.64), as were patients with better functional status (higher Palliative Performance Scale score: < 40, 64.8%; 40 to 70, 50.2%; OR, 0.79; 95% CI, 0.67 to 0.93; > 70, 40.5%; OR, 0.53; 95% CI, 0.35 to 0.82).


CONCLUSIONS
Increased hospice visit frequency may increase the likelihood of patients being able to die in the setting of their choice.
University of Pennsylvania Perelman School of Medicine, Philadelphia , PA 19104, USA.
Neha
N
Jeurkar
Sue
S
Farrington
Teresa R
TR
Craig
Julie
J
Slattery
Joan K
JK
Harrold
Betty
B
Oldanie
Joan M
JM
Teno
David J
DJ
Casarett
D000368:Aged; D015331:Cohort Studies; D005260:Female; D017051:Hospice Care; D006801:Humans; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies