Determinants of congruence between the preferred and actual place of death for terminally ill cancer patients

J Palliat Care. Winter 2003;19(4):230-7.

Abstract

A prospective cohort study was conducted to explore the extent of congruence and to identify the determinants of congruence between the preferred and actual place of death of terminally ill cancer patients. A total of 180 terminally ill cancer patients were enrolled (87% response rate) and 127 died during the one-year study period. Nearly 90% of the subjects preferred to die at home. One-third achieved their preference for place of death. The kappa value of congruence (kappa = 0.11, 95% confidence interval = 0.05-0.17) indicated poor to slight agreement between the preferred and actual place death. Important determinants of congruence between the preferred and actual place of death for terminally ill cancer patients included rehospitalisation and receiving hospice home care during the final days of life, perceived ability for family to help achieve preferred place of death, and residence in New Haven County.

Conclusions: This study directly confirms that the degree of congruence between the preferred and actual place death is unsatisfactory. Clinical interventions and health policies need to be developed to assist terminally ill cancer patients who may not be able to achieve their preference for place of end-of-life care and death.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Attitude to Death*
  • Choice Behavior*
  • Connecticut
  • Family / psychology
  • Female
  • Health Services Needs and Demand
  • Home Care Services / statistics & numerical data*
  • Hospices
  • Hospitalization / statistics & numerical data*
  • Humans
  • Length of Stay / statistics & numerical data
  • Likelihood Functions
  • Logistic Models
  • Male
  • Middle Aged
  • Neoplasms / psychology
  • Prospective Studies
  • Social Support
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Terminal Care / psychology*