FACTORS ASSOCIATED WITH LOCATION OF DEATH (HOME OR HOSPITAL) OF PATIENTS REFERRED TO A PALLIATIVE CARE TEAM

Objective: To identify factors associated with the location of death ( home or hospital) of patients referred to a palliative care home suppo rt team. Design: Retrospective case-control chart review. Setting: Pal liative care inpatient unit with a home support team in a large chroni c care hospital. Subjects: All 75 patients receiving services from the home support team who died at home between June 1988 and January 1990 and 75 randomly selected patients receiving the same services who die d in hospital. Outcome measures: Place of death (home or hospital). Re sults: Of the 267 patients referred to the palliative care home suppor t team during the study period 75 (28.1%) died at home. Factors signif icantly associated with dying at home were the patient's preference fo r dying at home recorded at the time of the initial assessment (P < 0. 001), a family member other than the spouse involved in the patient's care (P = 0.021) and the use of private shift nursing (P < 0.001). The patients who died in hospital were more likely than the other patient s to have had no home visits from the palliative care team after the i nitial assessment (P = 0.04). The patient's preference for dying al ho me was not met if the caregiver could not cope or if symptoms were unc ontrolled. The patient's preference For dying in hospital was not met if his or her condition deteriorated rapidly or if the patient died su ddenly. Conclusions: Patients' preference as to place of death, level of caregiver support and entitlement to private shift nursing were sig nificantly associated with patients' dying al home. The determination of these factors should be part of every palliative care assessment. P atients and their families should be informed about available home sup port services.