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Objective: This study investigated the association between use of sedatives in terminal cancer patients near death who were receiving home care and the home care period. Methods: We conducted a retrospective review of the medical records for 1032 cancer patients who received home palliative care from 17 specialized home care clinics between June and November 2013. We checked the use of sedatives within 48 hours before death at home, and we compared the home care period between patients with and without sedation. Results: The sedatives used were diazepam (n, %: 100, 52%), flunitrazepam (29, 15%), bromazepam (27, 14%), midazolam (26, 13%), and phenobarbital (20, 10%). The median home care period (median [quartiles]) was 26 [13, 63] days and 25 [10, 64] days (Adj p=0.79) for the patients with and without sedatives, respectively. Conclusion: Among terminal cancer patients near death receiving home care, 24% were administered sedatives, with more than half of those patients receiving diazepam. There was no association between use of sedatives and the home care period.
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Purpose: This study was performed to compare the characteristics of home palliative care for elderly patients with cancer between age groups. Methods: The clinical records of 1,032 patients with cancer who received home medical care from June to November 2013 were reviewed retrospectively. Patients were classified as non-elderly (<65 years old), young-old (65-74 years), old-old (75-84 years), or oldest-old (≥85 years), and these groups were compared with respect to demographic characteristics, patient/family problems, outcomes, and medical care and services provided. Results: There was a higher percentage of patients with no caregiver in the oldest-old group than in the other groups (18%, p=0.014), while the young-old and oldest-old groups had a higher percentage of problems related to caregiving such as caregiver burden or absence of a caregiver (32% and 33%, p=0.002, respectively). In addition, the percentage of patients who required visiting nurses and care was higher in the old-old group (86% and 30%, respectively) and oldest-old group (89% and 35%, respectively) compared with the other two groups. Conclusion: Problems related to caregiving, such as caregiver burden or absence of a caregiver, were greater in the old-old and oldest-old groups, and a higher percentage of patients required visiting nurses and care in those two groups.
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Purpose: This study investigated the current state of medical care and palliative care provided at home and the factors influencing death at home for terminally ill cancer patients living in single-person households. Methods: We conducted a retrospective questionnaire study of 1032 cancer patients living in single-person households who received home palliative care from 17 specialized home care clinics and finished home care between June and November 2013. We compared patient background factors, outcomes, home care services, and medical care between these patients and others not living in single-person households to investigate factors influencing death at home. Results: Compared with patients not living in single-person households, the patients living in single-person households were older, had a better performance status at initiation of home palliative care, showed a lower preference for dying at home, and received more frequent social hospitalization. Among the subjects from single-person households, factors influencing death at home were a family preference for dying at home (odds ratio (OR)=14.0), poor performance status at initiation of home palliative care (OR=4.0), and no hospitalization during home palliative care (OR=16.6). Conclusion: We found that death at home for terminally ill cancer patients living in single-person households and receiving home medical care and palliative care was influenced by family preference, the performance status at initiation of home palliative care, and hospitalization during home palliative care.
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Purpose: This study investigated the current state of critical hemorrhage during home palliative care for terminally ill cancer patients. Methods: We conducted a retrospective medical chart review of 7 cancer patients (1.4%) who received home palliative care from our clinic and died of critical hemorrhage at home from October 2007 to December 2014. Results: Four patients were male, the mean age was 70±11 years, and underlying diseases were different. None of the patients were accompanied by medical staff at the onset of bleeding. Six patients died at home and one patient was admitted to hospital for hemostasis. Six patients had a pre-hemorrhage episode more than 24 hours before critical hemorrhage occurred from the same site. One patient was administered a hemostatic agent, hemostasis was attempted in one, and one was given sedation. Six patients wanted to die at home, and did die at home. Discussion: If terminally ill cancer patients have critical hemorrhage at home, our options are limited. The results of this study suggest the importance of hemorrhage risk assessment and advance care planning.
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<b>Objectives:</b>To determine the factors influencing death or the cessation of palliative care in home-based setting among patients with cancer.<b> Methods:</b>We included 352 terminally ill patients with cancer who received home-based palliative care from six specialized palliative care clinics. We reviewed the medical charts when patients died at home or chose to stop home care.<b> Results:</b>A total of 82％ of participants died at home, and 18％ chose to stop home care. Multiple logistic regression analysis revealed five independent factors that affected cessation of home-based palliative care:patient and informal caregiver preferences for the place of death not to be at home［odds ratio, 10.1（95％ Confidential interval, 2.5-40.9）and 51.9（11.9-226.6）, respectively］or uncertain preferences［5.0（1.3-19.4）, 10.8（2.3-50.5）］;anxiety and depression among informal caregiver［4.1（1.2-13.9）］;lower frequency of informal care［6.8（2.0-23.4）］;and history of admittance to hospital during home care［11.6（4.0-33.9）］. <b>Conclusion:</b>We revealed independent factors influencing death or the cessation of palliative care in home-based settings among patients with cancer. Our findings suggest the importance of providing support for decision making about the place of death and hospital admission, and psychosocial support for informal caregiver to ensure home death consistent with patient preference.
ABSTRACT
<b>Purpose：</b>This study investigated the current state of medical care and home palliative care for terminally ill cancer patients in Japan. <b>Methods：</b>We conducted a retrospective questionnaire study of 352 cancer patients who received home palliative care from 6 specialized home care clinics and discontinued home care or died from January to June in 2012. <b>Results：</b>The questionnaire was answered by 290 patients〔165 men（57％）, mean age：72±13 years〕who started home palliative care after completing cancer treatment. Home visits from nurses were used by 238 patients（98％）and 95 patients（39％）used home care workers. Within a month before discontinuation of home care or death, 72 patients（30％）received fluid therapy and 127 patients（52％）received strong opioids. The outcome of home palliative care was death at home in 242 patients（83％）and discontinuation of home care in 48 patients（17％）. The reason for discontinuation was family physical and mental problems or physical problems of the patient. <b>Conclusion：</b>This study demonstrated the current state of home palliative care by specialized home care clinics.