title: Place of death and the differences in patient quality of death and dying and caregiver burden.
abstract: OBJECTIVE
  To explore the associations between place of death and quality of death and dying and caregiver burden in terminally ill patients with cancer and their families.
  
  
  METHODS
  Two bereavement surveys were conducted in October 2008 and October 2011. A total of 2,247 family caregivers of patients with cancer who were deceased responded to the mail surveys (response rate, 67%). Family members reported patient quality of death and dying and caregiver burden by using the Good Death Inventory and Caregiving Consequences Inventory.
  
  
  RESULTS
  Patient quality of death and dying was significantly higher at home relative to other places of dying after adjustment for patient and/or family characteristics (adjusted means): 5.0 (95% CI, 4.9 to 5.2) for home, 4.6 (95% CI, 4.5 to 4.7) for palliative care units, and 4.3 (95% CI, 4.2 to 4.4) for hospitals. For all combinations, pairwise P < .001; the size of the difference between home and hospital was moderate (Hedges' g, 0.45). Home was superior to palliative care units or hospitals with respect to "dying in a favorite place," "good relationships with medical staff," "good relationships with family," and "maintaining hope and pleasure" (P < .001 for all combinations of home v palliative care units and home v hospitals). Home death was significantly associated with a lower overall (P = .03) and financial caregiver burden (P = .004) relative to hospital death.
  
  
  CONCLUSIONS
  Dying at home may contribute to achieving good death in terminally ill patients with cancer without causing remarkably increased caregiver burden. Place of death should be regarded as an essential goal in end-of-life care.
authors.affiliation: Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan. maeda@pm.med.osaka-u.ac.jp.
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.affiliation: Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.affiliation: Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Akemi
authors.initials: A
authors.lastname: Yamagishi
authors.affiliation: Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shirahige
authors.affiliation: Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Takebayashi
authors.affiliation: Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Igarashi
authors.affiliation: Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University of Tokyo; and Kenji Eguchi, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001293:Attitude to Death; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003625:Data Collection / Q000379:methods / Q000706:statistics & numerical data; D003643:Death; D005190:Family / Q000523:psychology*; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D017051:Hospice Care / Q000191:economics / Q000523:psychology; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data; D013727:Terminal Care / Q000191:economics / Q000523:psychology; D019452:Terminally Ill / Q000523:psychology*