Where do our patients die? A review of the place of death of cancer patients in Cape Town, South Africa

Abstract

Objective: A 3-year review of the place of death of patients from a private oncology unit in Cape Town explores the length of time patients spent in acute care hospital beds, under the oncologist's care, prior to their death. Implications for improved staff training, patient support, and family education are identified.

Method: This is an exploratory quantitative study that captures details of place of death and particulars of length of acute care hospital stay for cancer patients of a private oncology unit. Data was gathered from 424 patient files, from January 2006 to December 2008, and is interpreted using simple descriptive statistics.

Results: Of the 424 recorded deaths, the average age at death was 66.09 years, with lung and bronchial cancer accounting for the leading diagnosis at death (23.82%). Most of patient deaths recorded (42.92%) occurred at home, with death under the oncologist's care in an acute medical ward comprising the second largest category (34.20%). The majority of the patients who died in this ward (38%) died within 3 days of admission.

Significance of results: Although medical and community support for end-of-life care at home are not uniformly available to all South Africans, the patients and families in this study had good access to hospice care, and achieved a higher "death at home" rate than that seen in several more developed countries. The review of place of death and length of hospitalization prior to death highlights the need for staff at private oncology units to be trained in and comfortable with palliative care. Attention is also drawn to the very real needs of carers and family members of patients, if death is planned to occur in the patient's home.