title: The relationship between cancer patients' place of death and bereaved caregivers' mental health status.
abstract: BACKGROUND
  Although place of death has been recognized as a risk factor in caregivers' bereavement adjustment, the estimation of the effect of the place of death needs careful consideration about many potential cofounders.
  
  
  METHODS
  This study was a nationwide cross-sectional questionnaire survey for bereaved family caregivers of patients with cancer who died in 3 settings: (1) hospice at home; (2) palliative care units (PCUs); and (3) acute hospitals. We assessed bereaved caregivers' depression, grief, insomnia, and the quality of dying of deceased patients across the 3 groups using propensity score weighting.
  
  
  RESULTS
  A total of 8968 responses were analyzed. According to scores on Patient Health Questionnaire 9, depressive symptoms were significantly higher in bereaved caregivers of patients who had died in acute hospitals (5.7; 95% confidence interval [CI]: 5.3-6.2) than for those of patients who had died in hospice at home (4.8; 95% CI: 4.4-5.1) or PCU (5.1; 95% CI: 5.0-5.2). Grief symptoms measured by Brief Grief Questionnaire were also significantly higher in caregivers of patients who had died in acute hospitals (5.0; 95% CI: 4.8-5.2) than those of patients who had died in hospice at home (4.7; 95% CI: 4.5-4.9) or PCU (4.7; 95% CI: 4.7-4.8). Deceased patients' quality of dying was highest in hospice at home, and worst in acute hospital.
  
  
  CONCLUSIONS
  The place where a cancer patient dies influences not only their quality of dying and death but also the mental health of their family caregivers. However, the absolute difference is not large after adjustment of multiple variables.
authors.affiliation: Department of Psychosomatic Medicine, Kindai University Faculty of Medicine, Higashi-osaka, Japan.
authors.forename: Yutaka
authors.identifier: http://orcid.org/0000-0002-9797-3487
authors.initials: Y
authors.lastname: Hatano
authors.affiliation: Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Maho
authors.initials: M
authors.lastname: Aoyama
authors.affiliation: Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Shizuoka, Hamamatsu, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Sendai, Japan.
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Gratia Hospital Hospice, Osaka, Japan.
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.affiliation: Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kizawa
authors.affiliation: Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuneto
authors.affiliation: Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Tsukuba, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.affiliation: Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
mesh_terms: D000368:Aged; D001293:Attitude to Death; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D003643:Death; D003863:Depression / Q000523:psychology*; D005260:Female; D006117:Grief; D017051:Hospice Care / Q000523:psychology; D006738:Hospices; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000523:psychology; D010166:Palliative Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: bereavement; cancer; caregiver; oncology; place of death; propensity score; quality of death and dying