Is dying in hospital better than home inincurable cancer and what factors influencethis? A population-based studyBarbara Gomes, Natalia Calanzani, Jonathan Koffman1

and Irene J. Higginson

Presented by Rashad Abdulmajid

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

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.

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

Place of death

Grief

Pain

Health service

s

Factors impacting decision of place of death.

Objective

Place :London , UK Period Mar ,2009~March 2010

Method: Case-control study352 cancer

patient

Died in hospital(n=175)

Died at home (n=177)

Questionnaire(relatives –death registration)

-Patient Pain the last week -Peace feeling .-Grief intensity-Health service availability

Cancer patient died at home

Cancer patient died at hospital

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

Palliative outcome scaleThe 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

IMD : index of multiple deprivationAssess the socio-economical wellness , housing ..

h

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.

Factors associated with dying at homePatient Preferences Relative preferences Community nursing services (Home palliative

care )

Factors associated with dying at hospitalProlonged hospitalization .Less or few Medical worker home visits .Few Number of days taken off family to look

after patient.

Preferences place of deathFamily support .Health care support

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

ConclusionDying 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 .

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