A Prospective Cohort Study of Factors Associated With Place of Death Among Patients With Late-Stage Cancer in Southern Africa.

Autor: Blanchard CL; Centre for Palliative Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Non Communicable Diseases Research Division, Wits Health Consortium, Johannesburg, South Africa. Electronic address: charmaine.blanchard@wits.ac.za., Ayeni O; MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Non Communicable Diseases Research Division, Wits Health Consortium, Johannesburg, South Africa., O'Neil DS; Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA., Prigerson HG; Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA., Jacobson JS; Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA., Neugut AI; Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA., Joffe M; MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Non Communicable Diseases Research Division, Wits Health Consortium, Johannesburg, South Africa., Mmoledi K; Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Centre for Palliative Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Non Communicable Diseases Research Division, Wits Health Consortium, Johannesburg, South Africa., Ratshikana-Moloko M; Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Centre for Palliative Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Non Communicable Diseases Research Division, Wits Health Consortium, Johannesburg, South Africa., Sackstein PE; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA., Ruff P; Division of Medical Oncology, Department of Internal Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa; Non Communicable Diseases Research Division, Wits Health Consortium, Johannesburg, South Africa.
Jazyk: angličtina
Zdroj: Journal of pain and symptom management [J Pain Symptom Manage] 2019 May; Vol. 57 (5), pp. 923-932. Date of Electronic Publication: 2019 Jan 30.
DOI: 10.1016/j.jpainsymman.2019.01.014
Abstrakt: Context: Identifying factors that affect terminally ill patients' preferences for and actual place of death may assist patients to die wherever they wish.
Objective: The objective of this study was to investigate factors associated with preferred and actual place of death for cancer patients in Johannesburg, South Africa.
Methods: In a prospective cohort study at a tertiary hospital in Johannesburg, South Africa, adult patients with advanced cancer and their caregivers were enrolled from 2016 to 2018. Study nurses interviewed the patients at enrollment and conducted postmortem interviews with the caregivers.
Results: Of 324 patients enrolled, 191 died during follow-up. Preferred place of death was home for 127 (66.4%) and a facility for 64 (33.5%) patients; 91 (47.6%) patients died in their preferred setting, with a kappa value of congruence of 0.016 (95% CI = -0.107, 0.139). Factors associated with congruence were increasing age (odds ratio [OR]: 1.03, 95% CI: 1.00-1.05), use of morphine (OR: 1.87, 95% CI: 1.04-3.36), and wanting to die at home (OR: 0.44, 95% CI: 0.24-0.82). Dying at home was associated with increasing age (OR 1.03, 95% CI 1.00-1.05) and with the patient wishing to have family and/or friends present at death (OR 6.73, 95% CI 2.97-15.30).
Conclusion: Most patients preferred to die at home, but most died in hospital and fewer than half died in their preferred setting. Further research on modifiable factors, such as effective communication, access to palliative care and morphine, may ensure that more cancer patients in South Africa die wherever they wish.
(Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: