Is dying in hospital better than home inincurable cancer and what factors influencethis? A population-based study

1. Is dying in hospital better than home in
incurable cancer and what factors influence
this? A population-based study
Barbara Gomes, Natalia Calanzani, Jonathan Koffman1 and
Irene J. Higginson
Presented by Rashad Abdulmajid

2. Why I chose this paper ?
- Address important issue regarding Palliative
care and end life management .
-Evaluate the relation between death place , Pain
, grief , Peace for patient and his family
-Medical workers tend to focus on the disease
forgetting the patient well , and psychological well
being sometime

3. What’s population study ?
Population study is a study of a group of individuals taken
from the general population who share a common
characteristic, such as age, sex, or health condition. This
group may be studied for different reasons, such as their
response to a drug or risk of getting a disease.

4. What’s palliative care ? Why it is important
for patient and family ?
 The medical care for people with serious illnesses. It focuses on providing patients with relief
from the symptoms and stress of a serious illness. The goal is to improve quality of life for both
the patient and the family.
① improves quality of life
② provides relief from pain and other distressing symptoms
③ supports life and regards dying as a normal process
④ combines psychological and spiritual aspects of care
⑤ offers a support system to help people live as actively as possible until death
⑥ offers a support system to help the family cope during a person’s illness and in bereavement
⑦ uses a team approach to address the needs of the person who is ill and their families

6. Place of death
Grief
Pain
Health
services
Factors impacting decision of place of death.
Objective
Place :London , UK Period Mar ,2009~March 2010

7. Method: Case-control study
352 cancer
patient
Died in hospital
(n=175)
Died at home
(n=177)
-Patient Pain the last week
-Peace feeling .
-Grief intensity
-Health service availability

8. Cancer patient died
at home
Cancer patient died
at hospital

9. Analysis
 Multivariate model
 Direct regression
 Multivariate ordinal regression(Pain and peace)
 Linear regression (for grief
 SPSS

10. Palliative outcome scale
 The POS measures are a family of tools to measure
patients' physical symptoms, psychological, emotional
and spiritual, and information and support needs. They
are validated instrument that can be used in clinical
care, audit, research and training
 0~4 , higher score indicate more pain .
TRIG is a questionnaire used to assess grief

11. IMD : index of multiple deprivation
Assess the socio-economical wellness , housing ..

12. h

23. Limitations
 -Retrosepctive study : association does not necessarily
indicate causality .
 Tranferability : this study was limited to London.
 Impact of non-response on the study result .
 Measurement of Pain , grief and peace depends on
responder.

24. Factors associated with dying at home
 Patient Preferences
 Relative preferences
 Community nursing services (Home palliative care )

25. Factors associated with dying at hospital
 Prolonged hospitalization .
 Less or few Medical worker home visits .
 Few Number of days taken off family to look after
patient.

26. Preferences place of death
 Family support .
 Health care support

27. Dying in home or hospital
-Dying in home has better experience and outcome in
term of peace and grief .
-both dying in hospital and home experienced similar pain

28. Conclusion
 Dying at home is better dying at hospital for peace and
grief .For advanced cancer patients , home can be a
ideal if they wish .
 Cooperation between medical care workers can make
home a suitable place of death .

32. Thank you !
ありがとうございます！
‫شكرا‬
谢谢大家！