Department of Public Health, Jichi Medical University, Shimotuke-shi, Tochigi, Japan.
PLoS One. 2013;8(3):e56848. doi: 10.1371/journal.pone.0056848. Epub 2013 Mar 8.
Discrepancy between preferred and actual place of death is common in cancer patients. While previous research has elucidated the factors associated with congruence between patients' preferred and actual place of death, it is not known how the perspective of the family influences the place of death. This study examined whether family preference for place of death mediates the relationship between patient preference and actual place of death.
A total of 258 cancer patients (home death, n = 142; hospital death, n = 116) who had received terminal care in Japan were analyzed. Measures included patients' demographic variables, patient and family preferences for place for death, actual place of death, patients' functional status, use and intensity of home care, availability of inpatient bed, living arrangement, and amount of extended family support.
Patient-family congruence on preferred place of death was 66% in patients who died at home and 47% in patients who died at other places (kappa coefficient: 0.20 and 0.25, respectively). In a multiple logistic regression model, patients were more likely to die at home when patients were male (odds ratio [OR], 95% confidence interval [CI]: 2.53, 1.06-6.05) and when their family preferred death at home (OR, 95% CI: 37.37, 13.82-101.03). A Sobel test revealed that family preference mediated the relationship between patient preference and place of death (p<0.05).
This study is, to our knowledge, the first to unveil the role of the family in the relationship between patient preference and place of death in Japan. In order to honor patients' wishes to die at home, supporting caregivers in the family may be an essential component of terminal care.
在癌症患者中，期望的死亡地点与实际死亡地点之间存在差异是很常见的。虽然之前的研究已经阐明了与患者期望的死亡地点与实际死亡地点之间的一致性相关的因素，但尚不清楚家庭的观点如何影响死亡地点。本研究旨在探讨家庭对死亡地点的偏好是否在患者偏好与实际死亡地点之间的关系中起中介作用。
共分析了 258 名在日本接受临终关怀的癌症患者（家中死亡，n=142；医院死亡，n=116）。测量包括患者的人口统计学变量、患者和家庭对死亡地点的偏好、实际死亡地点、患者的功能状态、家庭护理的使用和强度、住院床位的可用性、居住安排和大家庭支持的数量。
在家中死亡的患者中，患者-家庭在期望的死亡地点上的一致性为 66%，在其他地方死亡的患者中为 47%（kappa 系数：0.20 和 0.25）。在多因素逻辑回归模型中，当患者为男性（比值比[OR]，95%置信区间[CI]：2.53，1.06-6.05）和家庭希望在家中死亡时（OR，95%CI：37.37，13.82-101.03），患者更有可能在家中死亡。Sobel 检验表明，家庭偏好在患者偏好与死亡地点之间的关系中起中介作用（p<0.05）。
据我们所知，本研究首次揭示了家庭在日本患者偏好与死亡地点之间关系中的作用。为了尊重患者在家中死亡的意愿，支持家庭中的照顾者可能是临终关怀的一个重要组成部分。
