Determinants of preference for home death among terminally ill patients with cancer in Taiwan: a cross-sectional survey study

Abstract

Background: Studies worldwide have shown that most patients with cancer prefer to die at home. Few studies have directly explored the determinants of preference for home death in patients with cancer living in Asia, and none has been conducted in Taiwan.

Objectives: This study was designed to identify determinants of home-death preference among terminally ill patients with cancer in Taiwan.

Methods: A convenience sample of 2,188 terminally ill patients with cancer from 24 hospitals nationwide was surveyed. This study used multivariate logistic regression analysis to identify the determinants of preference for home death in the realms of patient demographics and disease characteristics, awareness of prognosis, and family support.

Results: Slightly more than half of the participants expressed the preference to die at home (n = 1,114, 54.7%). The adjusted odds of preferring to die at home were greater for participants described by one or more of the following: (1) family members knew the participant's preference for place of death (p < .001), (2) participant knew his or her prognosis (p = .032), (3) participant had greater functional dependency (p < .001), (4) participant was diagnosed with either liver/pancreatic (p = .028) or head/neck (p = .012) cancer, and (5) participant had less than a junior high school education (p < .001).

Conclusions/implications for practice: This study supports the argument that most terminally ill patients with cancer in Taiwan prefer to die at home. To achieve patient preferences for home death, healthcare professionals should provide prognostic information and initiate end-of-life care discussions among patients and their family to facilitate family understanding of their ill relative's place-of-death preference. Developing clinical interventions to alleviate physical symptoms and providing hospice homecare services for terminally ill patients with cancer, especially those with lung cancer and greater functional dependency, may facilitate a preference for and actualization of home death.