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Tytuł pozycji:

Impact on place of death in cancer patients: a causal exploration in southern Switzerland

Tytuł :
Impact on place of death in cancer patients: a causal exploration in southern Switzerland
Autorzy :
Heidi Kern
Giorgio Corani
David Huber
Nicola Vermes
Marco Zaffalon
Marco Varini
Claudia Wenzel
André Fringer
Pokaż więcej
Temat :
Cancer
End-of-life care
Palliative home care
Place of death
Communication
Family caregivers
Special situations and conditions
RC952-1245
Źródło :
BMC Palliative Care, Vol 19, Iss 1, Pp 1-10 (2020)
Wydawca :
BMC, 2020.
Rok publikacji :
2020
Kolekcja :
LCC:Special situations and conditions
Typ dokumentu :
article
Opis pliku :
electronic resource
Język :
English
ISSN :
1472-684X
Relacje :
http://link.springer.com/article/10.1186/s12904-020-00664-4; https://doaj.org/toc/1472-684X
DOI :
10.1186/s12904-020-00664-4
Dostęp URL :
https://doaj.org/article/a44522741cdc40869ad79aac6d245aca
Numer akcesji :
edsdoj.44522741cdc40869ad79aac6d245aca
Czasopismo naukowe
Abstract Background Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care. Methods A data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review. Results Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family’s preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient’s preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%. Conclusion Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family’s decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.
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