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Where do patients with cancer die in Belfast?

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Abstract

Background

Most patients with cancer prefer to die at home but the majority die in institutions.

Aim

To determine place of death for patients with cancer in Belfast, to examine changes over time and identify factors associated with place of death.

Methods

A survey of deaths registered in Belfast over a six-month period for 1977, 1987 and 1997 identified patients dying from cancer. Epidemiological data included age, gender, malignancy, social class, marital status, area of residence and place of death.

Results

Home deaths fell from 35% in 1977 to 28% in 1997. Hospital deaths fell from 50% in 1977 to 40% in 1987 rising to 42% in 1997. Hospice deaths rose from 13% in 1977 to 25% in 1987 falling to 23% in 1997. There was an association between place of death and age, marital status, type of cancer and area of residence, but not with social class or gender.

Conclusion

The majority of people fail to achieve a home death. Resources need to be targeted to those most at risk of an institutional death; females, the elderly, the unmarried, those with haematological malignancies and residents of South Belfast.

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References

  1. Thorpe G. Enabling more dying people to remain at home.Br Med J 1993; 307: 915–8.

    Article  CAS  Google Scholar 

  2. Groth-Juncker A-M, McCusker J. Where do elderly patients prefer to die? Place of death and patient characteristics of 100 elderly patients under the care of a home healthcare team.J Am Ger Soc 1983; 31(8): 457–61.

    CAS  Google Scholar 

  3. Townsend J, Frank AO, Fermont D et al. Terminal cancer care and patients’ preference for place of death: a prospective study.Br Med J 1990; 301: 415–7.

    Article  CAS  Google Scholar 

  4. Hinton J. Which patients with terminal cancer are admitted from home carerPalliative Med 1994; 8: 197–210.

    Article  CAS  Google Scholar 

  5. Dunlop RJ, Davies RJ, Hockley JM. Preferred vs actual place of death: a hospital palliative care support team experience.Palliative Med 1989; 3: 197–201.

    Article  Google Scholar 

  6. Cartwright A. Balance of care for the dying between hospitals and the community: perceptions of general practitioners, hospital consultants, community nurses and relatives.Br J Gen Pract 1991; 41: 271–4.

    PubMed  CAS  Google Scholar 

  7. Addington-Hall J, MacDonald L, Anderson H, Freeling P. Dying from cancer: the views of bereaved family and friends about the experiences of terminally ill patients.Palliative Med 1991; 5: 207–14.

    Article  Google Scholar 

  8. Bowling A. The hospitalisation of death: should more people die at home?J Med Ethics 1983; 9: 158–61.

    Article  PubMed  CAS  Google Scholar 

  9. Gray D, MacAdam D, Boldy D. A comparative cost analysis of terminal cancer care in home hospice patients and controls.J Chron Dis 1987; 40(8): 801–10.

    Article  PubMed  CAS  Google Scholar 

  10. Higginson I, Astin P, Dolan S. Where do cancer patients die? Ten-year trends in the place of death of cancer patients in England.Palliative Med 1998; 12: 353–63.

    Article  CAS  Google Scholar 

  11. Higginson I, Sen-Gupta G. Meeting the needs of cancer patients who wish to remain at home until they die: A systematic literature review of preferences, problems and cost-effective solutions: King’s College School of Medicine & Dentistry; 1997 London.

    Google Scholar 

  12. Seamark DA, Thorne CP, Lawrence C, Pereira Gray DJ. Appropriate place of death for cancer patients: views of general practitioners and hospital doctors.Br J Gen Pract 1995; 45: 359–63.

    PubMed  CAS  Google Scholar 

  13. Hays JC. Patient symptoms and family coping: predictors of hospice utilization patterns.Cancer Nursing 1986; 9(6): 317–25.

    Article  PubMed  CAS  Google Scholar 

  14. Herd E. Terminal care in a semi-rural area.Br J Gen Pract 1990; 40: 248–51.

    PubMed  CAS  Google Scholar 

  15. Blyth A. Audit of terminal care in a general practice.Br Med J 1990; 300: 983–6.

    Article  CAS  Google Scholar 

  16. Jones R, Hansford J, Fiske J. Death from cancer at home: the carers’ perspective.Br Med J 1993; 306: 249–51.

    Article  CAS  Google Scholar 

  17. Field D, McGaughey J. An evaluation of palliative care services for cancer patients in the Southern Health and Social Services Board of Northern Ireland.Palliative Med 1998; 12: 83–97.

    Article  CAS  Google Scholar 

  18. Doyle D, Parry K, MacFarlane R. Education in terminal care.J R Coll Gen Pract 1982; 32: 335–8.

    PubMed  CAS  Google Scholar 

  19. Lloyd-Williams M, Lloyd-Williams F. Palliative care teaching and today’s general practitioners — is it adequate?Eur J Cancer Care 1996; 5: 242–5.

    Article  CAS  Google Scholar 

  20. Millar D. Palliative care experience and training of Scottish General Practitioner Trainees.Health Bulletin 1996; 54(3): 248–51.

    PubMed  CAS  Google Scholar 

  21. Porta M, Busquet X, Jariod M. Attitudes and views of physicans and nurses towards cancer patients dying at home.Palliative Med 1997; 11: 116–26.

    Article  CAS  Google Scholar 

  22. Cartwright A. Dying when you’re old.Age and Ageing 1993; 22: 425–30.

    Article  PubMed  CAS  Google Scholar 

  23. Axelsson B, Christensen SB. Place of death correlated to sociodemographic factors. A study of 203 patients dying of cancer in a rural Swedish county in 1990.Palliative Med 1996; 10: 329–35.

    Article  CAS  Google Scholar 

  24. Sims A, Radford J, Doran K, Page H. Social class variation in place of cancer death.Palliative Med 1997; 11: 369–73.

    Article  CAS  Google Scholar 

  25. Clifford CA, Jolley DJ, Giles GG. Where people die in Victoria.Med J Aust 1991; 155: 446–56.

    PubMed  CAS  Google Scholar 

  26. Roder D, Bonett A, Hunt R, Beare M. Where patients with cancer die in South Australia.Med J Aust 1987; 147: 11–3.

    PubMed  CAS  Google Scholar 

  27. Higginson I, Webb D, Lessof L. Reducing hospital beds for patients with advanced cancer.Lancet 1994; 344(8919): 409.

    Article  PubMed  CAS  Google Scholar 

  28. Mor V, Hiris J. Determinants of site of death among hospice cancer patients.J Health Soc Behav 1983; 24: 375–85.

    Article  PubMed  CAS  Google Scholar 

  29. Catalan-Fernandez JG, Pons-Sureda O, Recober-Martinez A et al. Dying of cancer. The place of death and family circumstances.Med Care 1991; 29(9): 841–51.

    Article  PubMed  CAS  Google Scholar 

  30. McCusker J. Where cancer patients die: an epidemiologic study.Pub Health Rep 1983; 98(2): 170–6.

    CAS  Google Scholar 

  31. Hunt R, McCaul K. A population-based study of the coverage of cancer patients by hospice services.Palliative Med 1996; 10: 5–12.

    Article  CAS  Google Scholar 

  32. Gilbar O, Steiner M. When death comes: where should patients die?Hosp J 1996; 11(1): 31–48.

    Article  PubMed  CAS  Google Scholar 

  33. Polissar L, Severson RK, Brown NK. Factors affecting place of death in Washington State, 1968–1981.J Community Health 1987; 12(1): 40–55.

    Article  PubMed  CAS  Google Scholar 

  34. Dunphy K, Amesbury B. A comparison of hospice and home care patients: patterns of referral, patient characteristics and predictors of place of death.Palliative Med 1990; 4: 105–11.

    Article  Google Scholar 

  35. Komesaroff PA, Moss CK, Fox RM. Patients’ socioeconomic background: influence on selection of inpatient or domiciliary hospice terminal-care programmes.Med J Aust 1989; 151: 196–201.

    PubMed  CAS  Google Scholar 

  36. Sahlberg-Blom E, Ternestedt B-M, Johansson J-E. The last month of life: continuity, care site and place of death.Palliative Med 1998; 12: 287–96.

    Article  CAS  Google Scholar 

  37. Gochman D, Bonham G. Physicians and the hospice decision: awareness, discussion, reasons and satisfaction.Hosp J 1988; 4(1): 25–53.

    Article  PubMed  CAS  Google Scholar 

  38. Duke S. An analytical study of the changing health of a hospice population 1978–1989.Palliative Med 1997; 11: 145–51.

    Article  CAS  Google Scholar 

  39. Hearn J, Higginson I. Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review.Palliative Med 1998; 12: 317–32.

    Article  CAS  Google Scholar 

  40. Grande GE, Addington-Hall JM, Todd CJ. Place of death and access to home care services: are certain groups at a disadvantage?Soc Sci Med 1998; 47(5): 565–79.

    Article  PubMed  CAS  Google Scholar 

  41. Department of Employment. Classification of Occupations and Directory of Occupational Titles: Her Majesty’s Stationery Office, 1972.

  42. Office of Population Censuses and Surveys. Standard Occupational Classification. London: HMSO, 1991.

    Google Scholar 

  43. The Royal Mail. The Postal Address Book 95–96 Northern Ireland: Royal Mail.

  44. Northern Ireland Cancer Registry. Cancer Deaths in Northern Ireland. An analysis of patterns and trends. 1995.

  45. Wenning GK, Quinn NP, Daniel SE. How accurate is death certification of multiple system atrophy?Lancet 1992; 340: 1481–2.

    Article  PubMed  CAS  Google Scholar 

  46. Northern Ireland Cancer Registry. Cancer Incidence in Northern Ireland 1993–95: The Stationery Office, 1999.

  47. Franks P, Salisbury C, Bosanquet N et al. The level of need for palliative care: a systematic review of the literature.Palliative Med 2000; 14: 93–104.

    Article  CAS  Google Scholar 

  48. Mills M, Davies H, Macrae W. Care of dying patients in hospital.Br Med J 1994; 309: 583–6.

    CAS  Google Scholar 

  49. Rogers A, Karlsen S, Addington-Hall J. “All the services were excellent. It is when the human element comes in that things go wrong.” Dissatisfaction with hospital care in the last year of life.J Adv Nun 2000; 31(4): 768–74.

    Article  CAS  Google Scholar 

  50. Edmonds P, Stuttaford J, Penny J, Lynch A, Chamberlain J. Do hospital palliative care teams improve sympton control? Use of a modified STAS as an evaluation tool.Palliative Med 1998; 12(5): 345–51.

    Article  CAS  Google Scholar 

  51. Hockley J, Dunlop R, Davies R. Survey of distressing symptoms in dying patients and their families in hospital and the response to a symptom control team.Br Med J (Clin Res Ed) 1988; 18(296[6638]): 1715–7.

    Article  Google Scholar 

  52. Grande G, Todd C, Barclay S, Farquhar M. Does hospital at home for palliative care facilitate death at home? A randomised, controlled trial.Br Med J 1999; 319(7223): 1472–5.

    CAS  Google Scholar 

  53. Grande G, Todd C, Barclay S, Farquhar M. A randomised, controlled trial of a hospital at home service for the terminally ill.Palliative Med 2000; 14(5): 375–85.

    Article  CAS  Google Scholar 

  54. Scottish Health Feedback. Evaluation of a pilot scheme for providing ‘Macmillan Home Carers’ in Caithness. Final report for Cancer Relief Macmillan Fund. Edinburgh: Scottish Health Feedback, 1996.

    Google Scholar 

  55. Clark D, Ferguson C, Nelson C. Macmillan Carers Schemes in England: results of a multicentre evaluation.Palliative Med 2000; 14(2): 129–39.

    Article  CAS  Google Scholar 

  56. Addington-Hall J, Altmann D, McCarthy M. Which terminally ill cancer patients receive hospice in-patient care?Soc Sci Med 1998; 46(8): 1011–6.

    Article  PubMed  CAS  Google Scholar 

  57. Douglas C. For all the Saints.Br Med J 1992; 304: 579.

    Article  Google Scholar 

  58. Avis M. Evaluation of a project providing community palliative care support to nursing homes.Health Soc Care Comm 1999; 7(1): 32–8.

    Article  Google Scholar 

  59. Scottish Office. Nursing Homes Scotland Core Standards Section 5 Nursing Homes Registered to ProvidePalliative Care: NHS; 1998. Report No.: MEL (98)21.

  60. Karlsen S, Addington-Hall J. How do cancer patients who die at home differ from those who die elsewhere?Palliative Med 1998; 12: 279–86.

    Article  CAS  Google Scholar 

  61. McWhinney IR, Martin MJ, Orr V. Factors associated with location of death (home or hospital) of patients referred to a palliative care team.Can Med Ass J 1995; 152(3): 361–7.

    CAS  Google Scholar 

  62. Carroll DS. An audit of place of death of cancer patients in a semi-rural Scottish practice.Palliative Med 1998; 12: 51–3.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Epidemiology and Public Health, Queen’s University of Belfast, Northern Ireland

    M. Stevenson

  2. Department of General Practice, Queen’s University of Belfast, Dunluce Health Centre, 1 Dunluce Avenue, BT9 7HR, Belfast, Northern Ireland

    D. Davison, G. Johnston, P. Reilly & M. Stevenson

Authors
  1. D. Davison
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  2. G. Johnston
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  3. P. Reilly
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  4. M. Stevenson
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Correspondence to D. Davison.

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Davison, D., Johnston, G., Reilly, P. et al. Where do patients with cancer die in Belfast?. Ir J Med Sci 170, 18–23 (2001). https://doi.org/10.1007/BF03167714

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