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Determinants of death in an inpatient hospice for terminally ill cancer patients

Published online by Cambridge University Press:  19 July 2005

SIEW TZUH TANG ,
RUTH MCCORKLE  and
ELIZABETH H. BRADLEY ph.d.
SIEW TZUH TANG
Affiliation:
School of Nursing, National Yang-Ming University, Taipei, Taiwan School of Nursing, Yale University, New Haven, Connecticut
RUTH MCCORKLE
Affiliation:
School of Nursing, Yale University, New Haven, Connecticut
ELIZABETH H. BRADLEY ph.d.
Affiliation:
School of Public Health, Yale University, New Haven, Connecticut
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Abstract

Objective: Despite the strong emphasis on home-based end-of-life care in the United States and the recognition of dying at home as a gold standard of quality of care, hospice home care is not a panacea and death at home may not be feasible for every terminally ill cancer patient. Admission to an inpatient hospice and dying there may become a necessary and appropriate solution to distressing patients or exhausted families. However, the factors associated with death in an inpatient hospice have not been examined in previous studies.

Methods: A prospective cohort study was conducted to investigate the determinants of death in an inpatient hospice for terminally ill cancer patients. Approximately two-fifths (40.8%) of the 180 terminally ill cancer patients in this study died in inpatient hospices over the 3-year study period.

Results: Results from Cox proportional hazards model with adjustment for covariates revealed several factors that were significantly associated with dying in inpatient hospice, as opposed to home, in a nursing home, or in the hospital. Patients were more likely to die in an inpatient hospice if they received hospice care before death (hazard ratio [HR] = 7.32, 95% confidence interval [CI]: 3.21–16.67), if they had a prestated preference to die in an inpatient hospice (HR = 4.86, 95% CI: 2.24–10.51), if they resided in New Haven County (HR = 1.70, 95% CI: 1.00–2.93), or if they experienced higher levels of functional dependency (HR = 1.05, 95% CI: 1.02–1.08).

Significance of results: The high prevalence of inpatient hospice deaths for terminally ill cancer patients in this study was related to the local health care system characteristics, health care needs at the end of life, and personal preference of place of death. Findings from this study may shed light on future directions for developing end-of-life care tailored to the needs of cancer patients who are admitted to hospices and eventually die there.

Keywords

Place of deathInpatient hospice deathsTerminally ill cancer patientsEnd-of-life care
Type
Research Article
Information
Palliative & Supportive Care , Volume 2 , Issue 4 , December 2004 , pp. 361 - 370
Copyright
© 2004 Cambridge University Press

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References

REFERENCES

Addington-Hall, J., Altmann, D., & McCarthy, M. (1998). Which terminally ill cancer patients receive hospice in-patient care? Social Science & Medicine, 46, 1011–1016.Google Scholar
Benoliel, J.Q., McCorkle, R., & Young, K. (1980). Development of a social dependency scale. Research in Nursing & Health, 3, 3–10.Google Scholar
Bradley, P.J. (2003). Family caregiver assessment: Essential for effective home health care. Journal of Gerontological Nursing, 29, 29–36.Google Scholar
Bruera, E., Neumann, C., Brenneis, C., et al. (2000). Frequency of symptom distress and poor prognostic indicators in palliative care patients admitted to a tertiary palliative care unit, hospices, and acute care hospitals. Journal of Palliative Care, 16, 16–21.Google Scholar
Bruera, E., Russell, N., Sweeney, C., et al. (2002). Place of death and its predictors for local patients registered at a comprehensive cancer center. Journal of Clinical Oncology, 20, 2127–2133.Google Scholar
Cantwell, P., Turco, S., Brenneis, C., et al. (2000). Predictors of home death in palliative care cancer patients. Journal of Palliative Care, 16, 23–28.Google Scholar
Cobbs, E.L. (2001). Improving quality in end-of-life care: Dying at home. Journal American Geriatric Society, 49, 831–832.Google Scholar
Costantini, M., Balzi, D., Garronec, E., et al. (2000). Geographical variations of place of death among Italian communities suggest an inappropriate hospital use in the terminal phase of cancer disease. Public Health, 114, 15–20.Google Scholar
Doyle, D. (1998). The provision of palliative care. In Oxford Textbook of Palliative Medicine (2nd ed.), Doyle, D., Hanks, G.W.C. & MacDonald, N. (Eds.), pp. 41–53. New York: Oxford University Press.
Dunphy, K.P. & Amesbury, B.D.W. (1990). A comparison of hospice and home care patients: Patterns of referral, patient characteristics and predictors of place of death. Palliative Medicine, 4, 105–111.Google Scholar
Emanuel, E.J. & Emanuel, L.L. (1998). The promise of a good death. Lancet, 351(Suppl. II), 21–29.Google Scholar
Fried, T.R., van Doorn, C., O'Leary, J.R., et al. (1999). Older persons' preferences for site of terminal care. Annals of Internal Medicine, 131, 109–112.Google Scholar
Gallo, W.T., Baker, M.J., & Bradley, E.H. (2001). Factors associated with home versus institutional death among cancer patients in Connecticut. Journal American Geriatric Society, 49, 771–777.Google Scholar
Gatrell, A.C., Harman, J.C., Francis, B.J., et al. (2003). Place of death: An analysis of cancer death in part of North West England. Journal of Public Health and Medicine, 25, 53–58.Google Scholar
Gilbar, O. & Steiner, M. (1996). When death comes: Where should patients die? Hospice Journal, 11, 31–48.Google Scholar
Grande, G.E., Addington-Hall, J.M., & Todd, C.J. (1998). Place of death and access to home care services: Are certain patient groups at a disadvantage? Social Science & Medicine, 47, 565–579.Google Scholar
Hearn, J. & Higginson, I.J. (1998). Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliative Medicine, 12, 317–332.Google Scholar
Higginson, I.J., Astin, P., & Dolan, S. (1998). Where do cancer patients die? Ten-year trends in the place of death of cancer patients in England. Palliative Medicine, 12, 353–363.Google Scholar
Higginson, I.J. & Sen-Gupta, G.J.A. (2000). Place of care in advanced cancer: A qualitative systematic literature review of patient preferences. Journal of Palliative Medicine, 3, 287–300.Google Scholar
Hinton, J. (1994). Can home care maintain an acceptable quality of life for patients with terminal cancer and their relatives? Palliative Medicine, 8, 183–196.Google Scholar
Hogan, C., Lunney, J., Gabel, J., et al. (2001). Medicare beneficiaries' costs of care in the last year of life. Health Affairs, 20, 188–195.Google Scholar
Hunt, R.W., Bonett, A., & Roder, D. (1993). Trends in the terminal care of cancer patients: South Australia, 1981–1990. Australia New Zealand Journal of Medicine, 23, 245–251.Google Scholar
Hunt, R.W., Fazekas, B.S., Luke, C.G., et al. (2001). Where patients with cancer die in South Australia, 1990–1999: A population-based review. Medical Journal of Australia, 175, 526–529.Google Scholar
Institute of Medicine. (1997). Approach Death: Improving Care at the End of Life (p. 4). Washington, DC: National Academy Press.
Karlsen, S. & Addington-Hall, J. (1998). How do cancer patients who die at home differ from those who die elsewhere? Palliative Medicine, 12, 279–286.Google Scholar
Lupu, D.E. (1996). Hospice inpatient care: An overview of NHO's 1995 inpatient survey results. Hospice Journal, 11, 21–39.Google Scholar
McCarthy, E.P., Phillips, R.S., Zhong, Z., et al. (2000). Dying with cancer: Patients' function, symptoms, and care preferences as death approaches. Journal of the American Geriatric Society, 48, S110–S121.Google Scholar
McCorkle, R., Benoliel, J.Q., Donaldson, G., et al. (1989). Randomized clinical trial of home nursing care for lung cancer patients. Cancer, 64, 199–206.Google Scholar
McCorkle, R., Cooley, M.E., & Shea, J.A. (1998). A User's Manual for the Symptom Distress Scale. New Haven, CT: Yale University School of Nursing.
McCorkle, R. & Young, K. (1978). Development of a symptom distress scale. Cancer Nursing, 1, 373–378.Google Scholar
McWhinney, I.R., Bass, M.J., & Orr, V. (1995). Factors associated with location of death (home or hospital) of patients referred to a palliative care team. Canadian Medical Association Journal, 152, 361–367.Google Scholar
Mor, V. & Hiris, J. (1983). Determinants of site of death among hospice cancer patients. Journal of Health and Social Behavior, 24, 375–384.Google Scholar
Mor, V., Wachtel, T.J., & Kidder, D. (1985). Patient predictors of hospice care: Hospital versus home care programs. Medical Care, 23, 1115–1119.Google Scholar
National Center of Health Statistics. (2002). Death by place of death, age, race and sex: United States, 2000—CDC/NCHS National Vital Statistics System. Mortality unpublished tables. Accessed September 1, 2003. www.cdc.gov/nchs/data/statab/mortfomal2000_work309.pdf.
National Hospice and Palliative Care Organization. (2002). NHPCO Facts and Figures. Alexandria, VA: National Hospice and Palliative Care Organization.
National Hospice Organization. (1999). The 1997–8 Guide to the Nation's Hospices. Arlington, VA: National Hospice Organization.
Patrick, D.L., Engelberg, R.A., & Curtis, J.R. (2001). Evaluating the quality of dying and death. Journal of Pain and Symptom Management, 22, 717–726.Google Scholar
Pritchard, R.S., Fisher, E.S., Teno, J.M., et al. (1998). Influence of patient preferences and local health system characteristics on the place of death. Journal of the American Geriatric Society, 46, 1242–1250.Google Scholar
Roder, D., Bonett, A., Hunt, R., et al. (1987). Where patients with cancer die in South Australia. Medical Journal of Australia, 147, 11–13.Google Scholar
Ryan, C.W. (2000). Association between administrative and ownership characteristics of hospices and their proportion of inpatient death. Hospice Journal, 15, 63–74.Google Scholar
Scitovsky, A.A. (1994). “The high cost of dying” revisited. Milbank Quarterly, 72, 561–591.Google Scholar
Sims, A., Radford, J., Doran, K., et al. (1997). Social class variation in place of cancer death. Palliative Medicine, 11, 369–373.Google Scholar
State of Connecticut. (2002). State of Connecticut Office of Health Care Access Health System Data—Acute care staffed beds, FY 1998–2000. Accessed February 25, 2002. http://www.ohca.state.ct.us/HealthData/StatewideTable/Acutecarestaffedbeds.pdf.
Stewart, A., Teno, J., Patrick, D., et al. (1999). The concept of quality of life of dying persons in the context of health care. Journal of Pain and Symptom Management, 17, 93–108.Google Scholar
Tang, S.T. (2003a). When death is imminent, where terminally ill cancer patients prefer to die and why. Cancer Nursing, 26, 245–251.Google Scholar
Tang, S.T. (2003b). Determinants of hospice home care use among terminally ill cancer patients. Nursing Research, 52, 217–225.Google Scholar
Wennberg, J.E. & Cooper, M.M. (1998). The Dartmouth Atlas of Health Care, 1998. Chicago: American Hospital Publishing.