Table 2:
Determinants of Home Versus Hospital Death—Results of Observational Studies
| Determinant | Number of Studies | Adjusted OR (95% CI) | I2, if meta-analysis performed |
|---|---|---|---|
| Nurse Home Visits | |||
| Nurse home visits to home care recipients (vs. no visits) | 1 study (24) | 3.13 (1.08–6.21) | N/A |
| Increase in nurse home visits to home care recipients (≥ 2–3/week vs. < 2–3/week) | 2 studies (15, 22) | 1.31 (0.87–1.98) | 0 |
| Nurse home visits to general end-of-life population (vs. no visits) | 1 study (11) | 2.78 (2.01–3.85) | N/A |
| Increase in nurse home visits to general end-of-life population | 1 study (26) | Reference: no visits 1–3 visits: 3.13 | N/A |
| 4–12 visits: 8.77a | |||
| > 12 visits: 14.20a | |||
| Family Physician Home Visits | |||
| Family physician home visits to home care recipients (vs. no visits) | 2 studies (2, 15) | 2.01 (1.30–3.12) | 57% |
| Increase in family physician home visits to home care recipients (≥ 2.6/week vs. < 2.6/week) | 1 study (22) | 2.70 (0.95–7.70) | N/A |
| Family physician home visits to general end-of-life population (vs. no visits) | 1 study (11) | 12.50 (9.37–16.68) | N/A |
| Rate of family physician home visits to general end-of-life population during the last 3 months of life | 1 study (11) | Reference: no visits 0.6–1 visit: 9.10 (5.90– 14.30) | N/A |
| 1–2 visits: 14.30 (1.0– 20.0) | |||
| 2–4 visits: 16.70 (12.80– 25.0) | |||
| > 4 visits: 20.0 (12.5– 33.30) | |||
| Home Care Teams | |||
| Multidisciplinary home care team (vs. usual care or no multidisciplinary home care team) | 2 studies (13, 32) | 2.56 (2.31–2.83) 8.40 (4.67–15.09) | N/A |
| In-Hospital Palliative Care | |||
| In-hospital palliative support team or hospice unit (yes vs. no) | 2 studies (13, 23) | 0.54 (0.33–0.89) | 18% |
| Preference for Home Death | |||
| Patient preference for home death vs. no patient preference for home death (general end-of-life population) | 2 studies (2, 16) | 2.13 (1.58–2.87) | 0 |
| Patient preference for home death vs. no patient preference for home death (home care recipients) | 1 study (2, 13, 16) | 14.20 (9.43–21.38) | N/A |
| Family preference for home death vs. no family preference for home death (non-cancer patients) | 1 study (16) | 11.51 (8.28–15.99) | N/A |
| Family preference for home death vs. no family preference for home death (cancer patients) | 1 study (16) | 20.07 (12.24–32.88) | N/A |
| Congruence between patient and family preference (non-cancer patients), vs. no preference congruence | 1 study (16) | 12.33 (9.50–16.00) | N/A |
| Congruence between patient and family preference (cancer patients), vs. no congruence | 1 study (16) | 57.00 (38.74–83.86) | N/A |
| Disease-Related | |||
| Cancer (vs. other diseases) | 11 studies (14, 17–21, 24, 25, 27, 28, 30) | 1.93 (1.52–2.44) | 99% |
| Hematological cancer (vs. non-hematological cancer) | 3 studies (11, 21, 23) | 0.68 (0.53–0.87) | 83% |
| Cardiovascular disease (vs. other diseases) | 2 studies (20, 27) | 0.64 (0.63–0.65) | 0 |
| Major acute condition (vs. other diseases) | 1 study (28) | 0.29 (0.26–0.33) | N/A |
| Timing of Referral to Palliative Care | |||
| Time from referral to palliative care to death (≥ 1 vs. < 1 month) | 1 study (17) | 2.21 (1.33–3.67) | N/A |
| Functional Status | |||
| Worse functional status or bedridden (vs. better functional status or not bedridden) | 2 studies (15, 30) | 2.05 (1.33–3.15) | 0 |
| Prior Hospital Admission | |||
| ICU admission in the last year of life (vs. no ICU admission) | 1 study (23) | 0.82 (0.81–0.83) | N/A |
| ≥ 1 hospital admission during the last year of life (vs. no admission) | 1 study (20) | 0.15 (0.07–0.30) | N/A |
| Decision not to re-hospitalize in the event of a crisis (vs. no) | 1 study (31) | 40.11 (11.81–136.26) | N/A |
| Informal Caregiver-Related | |||
| Informal caregiver satisfaction with support from family physician (vs. dissatisfaction) | 1 study (2) | 1.62 (0.30–8.62) | N/A |
| Low informal caregiver psychological distress during stable phase (vs. high distress) | 1 study (31) | 5.41 (1.13–25.92) | N/A |
| Informal caregiver health (excellent/very good vs. fair/poor) | 1 study (2) | 0.64 (0.21–1.99) | N/A |
| Informal care (often vs. none or sometimes) | 1 study (13) | 2.30 (1.15–4.60) | N/A |
| Hospital Bed Availability | |||
| Unit increase/1,000 population | 3 studies (13, 19, 28) | 0.88 (0.84–0.92) | 66% |
| ≥ 65 vs. < 65/10,000 population | 1 study (12) | 0.75 (0.74–0.76) | N/A |
| ≥ 6.75 vs. < 6.75/1,000 population | 1 study (29) | 0.89 (0.83–0.95) | N/A |
| bed availability in 4th vs. 1st–3rd quarter | 1 study (23) | 0.79 (0.61–1.03) | N/A |
| Living Arrangements | |||
| Married (vs. not married) | 6 studies (11, 17, 18, 20, 23, 27) | 1.22 (1.11–1.33) | 71% |
| Not living alone (vs. living alone) | 4 studies (2, 19, 29, 30) | 2.09 (1.68–2.59) | 76% |
Abbreviations: CI, confidence interval; ICU, intensive care unit; N/A, not applicable; OR, odds ratio; vs., versus.
a
Statistically significant as per graph. P for trend not provided.