TY - JOUR

T1 - Population-based study of place of death of patients with cancer

T2 - implications for GPs

AU - Aabom, Birgit

AU - Kragstrup, Jakob

AU - Vondeling, Hindrik

AU - Bakketeig, Leiv S

AU - Støvring, Henrik

PY - 2005/9

Y1 - 2005/9

N2 - BACKGROUND: A majority of patients with cancer who are seriously ill have a preference of dying at home. However, only a minority of patients actually die at home in most Western countries.AIM: To explore factors associated with place of death in an unselected population of patients with cancer.DESIGN OF STUDY: Case-control study.SETTING: County of Funen, Denmark.METHOD: Register linkage from six Danish healthcare registers.RESULTS: The GP's home visit during the last 3 months before death was inversely associated with dying in hospital (adjusted odds ratio [OR] = 0.08, 95% confidence interval [CI] = 0.06 to 0.12) and so were community nurses visiting the home (OR = 0.36, 95% CI = 0.26 to 0.48). Furthermore, being married (OR = 0.68, 95% CI = 0.56 to 0.85), and age at death of 40-65 years (OR = 0.70, 95% CI = 0.56 to 0.90) seemed to have an effect. Hospital death was associated with survival time of less than 1 month (OR = 2.27, 95% CI = 1.69 to 3.13). Type of cancer, sex, or residence (urban versus rural) were not associated with a hospital death in this multivariate analysis.CONCLUSIONS: Dying at home was, to a higher extent, associated with GP visit and, to a lesser extent, community nurse visit than with clinical and sociodemographic characteristics of patients with cancer. In our view, these findings indicate the importance of the GP in particular. To increase the opportunity to die at home, more research is needed on the role of the GP and the interface between GPs and other providers of health care at home for patients who are terminally ill with cancer.

AB - BACKGROUND: A majority of patients with cancer who are seriously ill have a preference of dying at home. However, only a minority of patients actually die at home in most Western countries.AIM: To explore factors associated with place of death in an unselected population of patients with cancer.DESIGN OF STUDY: Case-control study.SETTING: County of Funen, Denmark.METHOD: Register linkage from six Danish healthcare registers.RESULTS: The GP's home visit during the last 3 months before death was inversely associated with dying in hospital (adjusted odds ratio [OR] = 0.08, 95% confidence interval [CI] = 0.06 to 0.12) and so were community nurses visiting the home (OR = 0.36, 95% CI = 0.26 to 0.48). Furthermore, being married (OR = 0.68, 95% CI = 0.56 to 0.85), and age at death of 40-65 years (OR = 0.70, 95% CI = 0.56 to 0.90) seemed to have an effect. Hospital death was associated with survival time of less than 1 month (OR = 2.27, 95% CI = 1.69 to 3.13). Type of cancer, sex, or residence (urban versus rural) were not associated with a hospital death in this multivariate analysis.CONCLUSIONS: Dying at home was, to a higher extent, associated with GP visit and, to a lesser extent, community nurse visit than with clinical and sociodemographic characteristics of patients with cancer. In our view, these findings indicate the importance of the GP in particular. To increase the opportunity to die at home, more research is needed on the role of the GP and the interface between GPs and other providers of health care at home for patients who are terminally ill with cancer.

KW - Adolescent

KW - Adult

KW - Aged

KW - Attitude to Death

KW - Case-Control Studies

KW - Denmark/epidemiology

KW - Family Practice/organization & administration

KW - Female

KW - Hospital Mortality

KW - House Calls/statistics & numerical data

KW - Humans

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Neoplasms/mortality

KW - Palliative Care/methods

KW - Patient Satisfaction

KW - Terminal Care/methods

KW - Terminally Ill/statistics & numerical data

M3 - Journal article

C2 - 16176735

VL - 55

SP - 684

EP - 689

JO - British Journal of General Practice

JF - British Journal of General Practice

SN - 0960-1643

IS - 518

ER -