Place of Death for Adults Receiving Specialist Palliative Care in Their Last 3 Months of Life: Factors Associated With Preferred Place, Actual Place, and Place of Death Congruence

TY - JOUR

T1 - Place of Death for Adults Receiving Specialist Palliative Care in Their Last 3 Months of Life

T2 - Factors Associated With Preferred Place, Actual Place, and Place of Death Congruence

AU - Smith, Samantha

AU - Brick, Aoife

AU - Johnston, Bridget

AU - Ryan, Karen

AU - McQuillan, Regina

AU - O'Hara, Sinead

AU - May, Peter

AU - Droog, Elsa

AU - Daveson, Barbara

AU - Morrison, R Sean

AU - Higginson, Irene J

AU - Normand, Charles

N1 - Publisher Copyright: © The Author(s) 2024.

PY - 2024/7

Y1 - 2024/7

N2 - Objectives: Congruence between the preferred and actual place of death is recognised as an important quality indicator in end-of-life care. However, there may be complexities about preferences that are ignored in summary congruence measures. This article examined factors associated with preferred place of death, actual place of death, and congruence for a sample of patients who had received specialist palliative care in the last three months of life in Ireland. Methods: This article analysed merged data from two previously published mortality follow-back surveys: Economic Evaluation of Palliative Care in Ireland (EEPCI); Irish component of International Access, Rights and Empowerment (IARE I). Logistic regression models examined factors associated with (a) preferences for home death versus institutional setting, (b) home death versus hospital death, and (c) congruent versus non-congruent death. Setting: Four regions with differing levels of specialist palliative care development in Ireland. Participants: Mean age 77, 50% female/male, 19% living alone, 64% main diagnosis cancer. Data collected 2011-2015, regression model sample sizes: n = 342-351. Results: Congruence between preferred and actual place of death in the raw merged dataset was 51%. Patients living alone were significantly less likely to prefer home versus institution death (OR 0.389, 95%CI 0.157-0.961), less likely to die at home (OR 0.383, 95%CI 0.274-0.536), but had no significant association with congruence. Conclusions: The findings highlight the value in examining place of death preferences as well as congruence, because preferences may be influenced by what is feasible rather than what patients would like. The analyses also underline the importance of well-resourced community-based supports, including homecare, facilitating hospital discharge, and management of complex (eg, non-cancer) conditions, to facilitate patients to die in their preferred place.

AB - Objectives: Congruence between the preferred and actual place of death is recognised as an important quality indicator in end-of-life care. However, there may be complexities about preferences that are ignored in summary congruence measures. This article examined factors associated with preferred place of death, actual place of death, and congruence for a sample of patients who had received specialist palliative care in the last three months of life in Ireland. Methods: This article analysed merged data from two previously published mortality follow-back surveys: Economic Evaluation of Palliative Care in Ireland (EEPCI); Irish component of International Access, Rights and Empowerment (IARE I). Logistic regression models examined factors associated with (a) preferences for home death versus institutional setting, (b) home death versus hospital death, and (c) congruent versus non-congruent death. Setting: Four regions with differing levels of specialist palliative care development in Ireland. Participants: Mean age 77, 50% female/male, 19% living alone, 64% main diagnosis cancer. Data collected 2011-2015, regression model sample sizes: n = 342-351. Results: Congruence between preferred and actual place of death in the raw merged dataset was 51%. Patients living alone were significantly less likely to prefer home versus institution death (OR 0.389, 95%CI 0.157-0.961), less likely to die at home (OR 0.383, 95%CI 0.274-0.536), but had no significant association with congruence. Conclusions: The findings highlight the value in examining place of death preferences as well as congruence, because preferences may be influenced by what is feasible rather than what patients would like. The analyses also underline the importance of well-resourced community-based supports, including homecare, facilitating hospital discharge, and management of complex (eg, non-cancer) conditions, to facilitate patients to die in their preferred place.

KW - Humans

KW - Male

KW - Female

KW - Palliative Care/statistics & numerical data

KW - Ireland

KW - Aged

KW - Patient Preference/statistics & numerical data

KW - Terminal Care/statistics & numerical data

KW - Middle Aged

KW - Aged, 80 and over

KW - Attitude to Death

KW - Adult

KW - Surveys and Questionnaires

KW - Logistic Models

KW - Home Care Services/statistics & numerical data

UR - http://www.scopus.com/inward/record.url?scp=85186870880&partnerID=8YFLogxK

U2 - 10.1177/08258597241231042

DO - 10.1177/08258597241231042

M3 - Article

C2 - 38404130

SN - 0825-8597

VL - 39

SP - 184

EP - 193

JO - Journal of Palliative Care

JF - Journal of Palliative Care

IS - 3

ER -