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

Published online by Cambridge University Press:  25 February 2011

Clare Manicom
Clare Manicom*
Affiliation:
GVI Oncology, Constantiaberg Medi-Clinic, Plumstead, Western Cape Province, South Africa
*
Address correspondence and reprint requests to: Clare Manicom, GVI Oncology, Constantiaberg Medi-Clinic, Burnham Road, Plumstead, 7800, Western Cape, South Africa. E-mail: clare.manicom@cancercare.co.za
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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.

Keywords

Place of deathEnd-of-life careHospitalization prior to cancer death
Type
Original Articles
Information
Palliative & Supportive Care , Volume 9 , Issue 1 , March 2011 , pp. 31 - 41
Copyright
Copyright © Cambridge University Press 2011

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References

REFERENCES

Agar, M., Currow, D.C., Shelby-James, T.M., et al. (2008). Preference for place of care and place of death in palliative care: Are these different questions? Palliative Medicine, 22, 787–795.CrossRefGoogle ScholarPubMed
Beccaro, M., Costantini, M., Rossi, P.G., et al. (2006). Actual and preferred place of death of cancer patients. Results from the Italian survey of the dying of cancer (ISDOC). Journal of Epidemiology and Community Health, 60, 412–416.CrossRefGoogle ScholarPubMed
Bowling, J. (1983). The hospitalisation of death: Should more people die at home? Journal of Medical Ethics, 9, 158–161.CrossRefGoogle ScholarPubMed
Brazil, K., Bedard, M. & Willison, K. (2002). Factors association with home death for individuals who receive home support services: A retrospective cohort study BioMed Central Palliative Care, 1, 2–7.CrossRefGoogle ScholarPubMed
Bruera, E., Russell, N., Sweeney, C., et al. (2002). Place of death and its predictors for local patients registered at a comprehensive cancer center. Journal of Clinical Oncology, 20, 8, 2127–2133.CrossRefGoogle Scholar
Clemens, K., Kumar, S., Bruera, E., et al. (2007). Palliative care in developing countries: What are the important issues? Palliative Medicine, 21, 173–175.CrossRefGoogle ScholarPubMed
Cohen, J., Bilsen, J., Addington-Hall, J., et al. (2008). Population-based study of dying in hospital in six European Countries. Palliative Medicine, 22, 702–710.CrossRefGoogle ScholarPubMed
Costantini, M., Beccaro, M. & Merlo, F. (2005). The last three months of life of Italian cancer patients. Methods, sample characteristics and response rate of the Italian Survey of the Dying of Cancer (ISDOC). Palliative Medicine, 19, 628–638.CrossRefGoogle ScholarPubMed
Costantini, M. (2008). Editorial: Place of death. It is time for a change of gear Palliative Medicine, 22, 785–786.CrossRefGoogle ScholarPubMed
Davies, E., Linklater, K., Jack, R., et al. (2006). How is place of death from cancer changing and what affects it? Analysis of cancer registration and service data. British Journal of Cancer, 95, 593–600.CrossRefGoogle Scholar
Decker, S. & Higginson, I. (2006). A tale of two cities: Factors affecting place of cancer death in London and New York. European Journal of Public Health, 17, 285–290.CrossRefGoogle ScholarPubMed
Ellershaw, J. & Ward, C. (2003). Care of the dying patient: The last hours or days of life British Medical Journal, 326, 30–34.CrossRefGoogle ScholarPubMed
Friedman, B.T., Harwood, M.K. & Shields, M. (2002). Barriers and enablers to hospice referrals: An expert overview. Journal of Palliative Medicine, 5, 73–81.CrossRefGoogle ScholarPubMed
Fukui, S., Fukui, N., Kawagoe, H., et al. (2004). Predictors of place of death for Japanese patients with advanced-stage malignant disease in home care settings: A nationwide survey. Cancer, 101, 421–429.CrossRefGoogle ScholarPubMed
Gagnon, B., Mayo, N.E., Hanley, J., et al. (2004). Pattern of care at the end of life: Does age make a difference in what happens to women with breast cancer? Journal of Clinical Oncology, 22, 3458–3465.CrossRefGoogle ScholarPubMed
Gomes, B. & Higginson, I. (2006). Factors influencing death at home in terminally ill patients with cancer: Systematic review. British Medical Journal, 332, 515–521.CrossRefGoogle ScholarPubMed
Gomes, B. & Higginson, I. (2008). Where people die (1974-2030): Past trends, future projections and implications for care. Palliative Medicine, 22, 33–41.CrossRefGoogle ScholarPubMed
Greeff, L. & Gouws, L. (2003). Making a difference: The multidisciplinary team approach to cancer care. The Specialist ForumOctober, 4–9.Google Scholar
Hallenbeck, J. (2008). Review article: Access to end-of-life care venues. American Journal of Hospice and Palliative Medicine, 25, 245–249.CrossRefGoogle ScholarPubMed
Kane, M.N., Hamlin, E.R. 2nd & Hawkins, W.E., et al. (2004). Measuring preparedness to address patient preferences at the end of life. American Journal of Hospice and Palliative Medicine, 21, 267–274.CrossRefGoogle ScholarPubMed
Kikule, E. (2003). A good death in Uganda: Survey of needs for palliative care for terminally ill people in urban areas. British Medical Journal, 327, 192–194.CrossRefGoogle ScholarPubMed
Koffman, J., et al. (2008). Palliative care: The magnitude of the problem. In Palliative Care: A Patient-Centred Approach. Mitchell, G. (ed). Abingdon, England: Radcliffe Publishing.Google Scholar
Lin, H-C., Lin, Y-J., Liu, T-C., et al. (2007). Urbanization and place of death for the elderly: A 10-year population-based study. Palliative Medicine, 21, 705–711.CrossRefGoogle ScholarPubMed
Mangan, P.A., Taylor, K.C., Yabroff, K.R., et al. (2003). Caregiving near the end of life: Unmet needs and potential solutions. Palliative and Supportive Care, 1, 247–259.CrossRefGoogle ScholarPubMed
McCarthy, E.P., Burns, R.B., Davis, R.B., et al. (2003). Barriers to hospice care among older patients dying with lung and colorectal cancer. Journal of Clinical Oncology, 21, 728–735.CrossRefGoogle ScholarPubMed
Montel, S., Laurence, V., Copel, L., et al. (2009). Place of death of adolescents and young adults with care: First study in a French population. Palliative and Supportive Care, 7, 27–35.CrossRefGoogle Scholar
Mqoqi, N., Kellett, P., Sitas, F., et al. (2004). Cancer in South Africa, 1998 – 1999. National Cancer Registry of South Africa, Johannesburg.Google Scholar
Nieumeyer, S. & Hosking, M. (2006). Counselling the terminally ill – Can we prepare for death? South African Family Practice, 48, 20–22.CrossRefGoogle Scholar
Parkin, D., Bray, F., Ferlay, J., et al. (2005). Global Cancer Statistics, 2002. CA: A Cancer Journal for Clinicians, 55, 74–108.Google ScholarPubMed
Parkin, D.M., Sitas, F., Chirenje, M., et al. (2008). Part 1: Cancer in Indigenous Africans – burden, distribution, and trends. Lancet Oncology, 9, 683–692.CrossRefGoogle ScholarPubMed
Phipps, E., Braitman, L.E., True, G., et al. (2003). Family care giving for patients at life's end: Report from the Cultural Variations Study (CVAS). Palliative and Supportive Care, 1, 165–170.CrossRefGoogle ScholarPubMed
Setel, P., Macfarlane, S.B., Szreter, S., et al. (2007). A scandal of invisibility: Making everyone count by counting everyone. The Lancet, 370, 1569–1577.CrossRefGoogle ScholarPubMed
South African Medical Research Council. (2009). What are the top causes of death in South Africa? www.mrc.ac.za (Accessed 5 May 2009).Google Scholar
Stajduhar, K. & Davies, B. (2005). Variations in and factors influencing family members’ decisions for palliative home care. Palliative Medicine, 19, 21–32.CrossRefGoogle ScholarPubMed
Waldrop, D. & Rinfrette, E. (2009). Can short hospice enrollment be long enough? Comparing the perspectives of hospice professionals and family caregivers. Palliative and Supportive Care, 7, 37–47.CrossRefGoogle ScholarPubMed
Willard, C. & Luker, K. (2006). Challenges to end of life care in the acute hospital setting. Palliative Medicine, 20, 611–615.CrossRefGoogle ScholarPubMed
Yach, D., Hawkes, C., Linn Gould, C., et al. (2004). The global burden of chronic diseases. Overcoming impediments to prevention and control. Journal of the American Medical Association, 291, 2616–2622.CrossRefGoogle ScholarPubMed