Background: Singapore's Home Ventilation and Respiratory Support Service (HVRSS) provides care for patients with chronic respiratory failure needing long-term home ventilation. Currently, data on the distribution of places of death (PODs) among these patients is lacking. We examined the distribution of POD among deceased HVRSS patients over a 10-year period and explored clinical factors potentially associated with specific death locations. Additionally, we assessed the agreement between patients' preferred POD (PPOD), as documented in Advance Care Planning (ACP), and their actual POD.
Methods: We conducted a retrospective cohort study of patients with at least one HVRSS encounter and who had died by 2019. Death-related information was obtained from an administrative dataset and linked with socio-demographic, clinical, and ACP data from other sources. Logistic regression was used to identify clinical factors associated with specific POD. Agreement analysis between actual POD and PPOD was performed among decedents with valid ACP documentation.
Results: Among 118 patients studied, 44% died at home, 53% in hospitals, and 3% elsewhere. ACP documentation was available for 52 patients (44.1%), with 73.1% of those preferring home as their POD. Clinical factors associated with home as POD included diagnosis of motor neuron disease (MND) [odds ratio (OR) =5.6; 95% confidence interval (CI): 1.2-25.0; P=0.02], ventilation status at death (OR =14.9; 95% CI: 3.8-58.3; P<0.001), and feeding type at death (OR =3.8; 95% CI: 1.0-14.0; P=0.044). The percentage agreement between actual POD and PPOD was 57.1% (95% CI: 43-72%; P<0.001) with a Gwet's AC1 coefficient of 0.49 (95% CI: 0.31-0.66; P<0.001), indicating moderate agreement.
Conclusions: This is the first study in Singapore to characterise POD patterns and associated factors among home ventilation patients, as well as to evaluate alignment between preferred and actual POD. These findings may inform policy and end-of-life care practices to better support HVRSS patients, particularly at their chosen POD.
Keywords: Advance Care Planning (ACP); Home ventilation; end-of-life preferences; place of death (POD).