Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T20:29:04.418Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors associated with location of death of children with cancer in palliative care

Published online by Cambridge University Press:  07 December 2005

ANDRÉA YAMAGUCHI KURASHIMA ,
MARIA DO ROSÁRIO DIAS LATORRE ,
SILVIA APARECIDA DE PAIVA TEIXEIRA  and
BEATRIZ DE CAMARGO
ANDRÉA YAMAGUCHI KURASHIMA
Affiliation:
Pediatric Department of Centro de Tratamento e Pesquisa, Hospital A. C. Camargo, Hospital do Câncer. São Paulo, Brazil
MARIA DO ROSÁRIO DIAS LATORRE
Affiliation:
Centro de Tratamento e Pesquisa, Hospital A. C. Camargo, Hospital do Câncer. São Paulo, Brazil
SILVIA APARECIDA DE PAIVA TEIXEIRA
Affiliation:
Social worker, Social Service of Centro de Tratamento e Pesquisa, Hospital A. C. Camargo, Hospital do Câncer. São Paulo, Brazil
BEATRIZ DE CAMARGO
Affiliation:
Pediatric Department of Centro de Tratamento e Pesquisa, Hospital A. C. Camargo, Hospital do Câncer. São Paulo, Brazil
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: The aim of this study was to identify factors associated with location of death of patients receiving palliative care in a pediatric oncology unit.

Methods: A palliative care program was developed in the pediatric department in order to provide specialized attention to the patient and family in end-of-life. The program is coordinated by a nurse, delivering a simultaneous interdisciplinary team approach with focus on identification and training of a family care provider as well as local resources supplemented by support of a social worker and the community. All 87 patients in palliative care were followed by the team. The factors associated with the location of death (home or hospital) were evaluated for the 71 patients who died prior to analysis.

Results: Forty-two (59%) patients died at home. Factors significantly associated with dying at home were: male with an Odds Ratio (OR) = 3.80, 95% Confidence Interval (CI) = 1.26–11.76; public health insurance (OR) = 4.95, 95%[CI] = 1.03–26.75, low educational level of the caregiver (OR) = 11.11 95%[CI] = 1.65–94.66 and low educational level of the mother (OR) = 7.07 95%[CI] = 1.37–40.14. Gender was the only independent factor associated with location of death: a boy had a higher risk of dying at home, (OR) = 4.25, 95%[CI] = 1.37–13.21 when compared to a girl.

Significance of results: In our society we are still not able to provide hospice care or home care for all children, although increasing emphasis has been placed on utilizing local resources. Even though we had increased the number of desired home deaths, it is still a challenge to meet patients and families' requests. A team approach, the recognition of the factors involved, and adequate health and community support have helped us to meet the child and family's needs.

Keywords

Palliative careLocation of deathPediatric oncology
Type
Research Article
Information
Palliative & Supportive Care , Volume 3 , Issue 2 , June 2005 , pp. 115 - 119
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Anonymous. (2000). The pediatrician and childhood bereavement. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. Pediatrics, 105, 445–447.Google Scholar
Adam, J. (1997). ABC of palliative care: The last 48 hours. BMJ, 315, 1600–1603.Google Scholar
Bruera, E. (1993). Palliative care in Latin America. Journal of Pain and Symptom Management, 8, 365–368.Google Scholar
Bruera, E., Neumann, C.M., Gagnon, B., et al. (1999). Edmonton Regional Palliative Care Program: Impact on patterns of terminal cancer care. CMAJ, 10, 161(3), 290–293.Google Scholar
Bruera, E., Russell, N., Sweeney, C., et al. (2002). Place of death and its predictors for local patients registered at a comprehensive cancer center. Journal of Clinical Oncology, 20, 2127–2133.Google Scholar
Cantwell, P., Turco, S., Brenneis, C., et al. (2000). Predictors of home death in palliative care cancer patients. Journal of Palliative Care, 16, 23–28.Google Scholar
Feudtner, C., Silveira, M.J., & Christakis, D.A. (2002). Where do children with complex chronic conditions die? Patterns in Washington State, 1980–1998. Pediatrics, 109, 656–660.Google Scholar
Grande, G.E., Addington-Hall, J.M., & Todd, C.J. (1998). Place of death and access to home care services: are certain patient groups at a disadvantage? Soc Sci Med, 47(5), 565–579. Review.Google Scholar
Hinton, J. (1994). Can home care maintain an acceptable quality of life for patients with terminal cancer and their relatives? Palliative Medicine, 8, 183–196.Google Scholar
Johnston, B. (1999). Overview of nursing developments in palliative care. In Palliative Care the Nursing Role, Lugton, J. & Kindlen, M. (eds.). Edinburgh: Churchill Livingstone.
Karlsen, S. & Addington-Hall, J. (1998). How do cancer patients who die at home differ from those who die elsewhere? Palliative Medicine, 12(4), 279–286.Google Scholar
Kurashima, A.Y. & de Camargo, B. (2003). Palliative and terminal care for dying children. Med Pediatr Oncology, 40(1), 72.Google Scholar
Robbins, M. (1998). Evaluating Palliative Care: Establishing the Evidence Base. New York: Oxford Medical Pu.
Townsend, J., Frank, A.O., Fermont, D., et al. (1990). Terminal cancer care and patients' preference for place of death: A prospective study. BMJ, 301(6749), 415–417.Google Scholar