Where do Brazilian cancer patients prefer to die? Agreement between patients and caregivers

Author(s)

de Oliveira Valentino, Talita Caroline ; de Oliveira, Marco Antonio ; Paiva, Carlos Eduardo ; Ribeiro Paiva, Bianca Sakamoto

• Document type: Journal article
• Source: JOURNAL OF PAIN AND SYMPTOM MANAGEMENT; v. 64, n. 2, p. 19-pg., 2022-08-01.

Abstract

Context. Preferred place-of-death (PPoD) is considered an important outcome for the development of appropriate models of care and for improving health policies in countries with underdeveloped palliative care (PC) Objectives. To determine the concordance between the PPoD of a sample of Brazilian seriously-ill cancer patients and their caregivers, and its associated factors under four different end-of-life (EOL) scenarios: 1) health deterioration in the overall context; 2) health deterioration with severe and uncomfortable symptoms; 3) health deterioration receiving home-based visits as needed; 4) health deterioration receiving home-based visits as needed, when suffering severe and uncomfortable symptoms Methods. Cross-sectional study at a large Brazilian cancer center, between February 2019 and July 2021. 190 adult cancer patients and their caregivers (n = 190) were analyzed Results. Patient and/or caregiver PPoD concordance for EOL scenario one: 64% vs. 43% for death at home, 22% vs. 30% for death in a PC unit, 14% vs. 27% for death in hospital. Higher patient and/or caregiver PPoD concordance was found for death in hospital (41%; 49%) in EOL scenario two, and for death at home for scenario three (77%; 74%). Agreement coefficient was moderate for scenario two (k = 0.430; P < 0.001), and fair for EOL scenarios one, three and four (k = 0.237, P < 0.001; k = 0.296, P < 0.001; k = 0.307, P < 0.001, respectively). Associated disagreement factors were: performance status (OR:3.03), self-perceived health (OR: 6.99), marital status (OR:2.92), and hospital and/or emergency room proximity (OR:4.11). The presence of relevant persons (42.3% vs. 44.2%), followed by spirituality (38.5% vs. 27.9%) and the place-of-death (14.0% vs. 18.4%), were the most important factors in the EOL, when comparing patients and care givers opinions, respectively Conclusion. Low agreement between patients and caregivers on PPoD was identified. EOL clinical factors and deterioration, and PC support seem to influence PPoD. J Pain Symptom Manage 2022;64:186-204. (c) 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. (AU)

• FAPESP's process: 18/08728-7 - Where patients with Cancer prefer to die? Association of preferences expressed in life and the reality of patients in Brazil, Portugal and England
• Grantee: Talita Caroline de Oliveira Valentino
• Support Opportunities: Scholarships in Brazil - Doctorate