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Factors associated with location of death of children with cancer in palliative care

Published online by Cambridge University Press:  07 December 2005

ANDRÉA YAMAGUCHI KURASHIMA
Affiliation:
Pediatric Department of Centro de Tratamento e Pesquisa, Hospital A. C. Camargo, Hospital do Câncer. São Paulo, Brazil
MARIA DO ROSÁRIO DIAS LATORRE
Affiliation:
Centro de Tratamento e Pesquisa, Hospital A. C. Camargo, Hospital do Câncer. São Paulo, Brazil
SILVIA APARECIDA DE PAIVA TEIXEIRA
Affiliation:
Social worker, Social Service of Centro de Tratamento e Pesquisa, Hospital A. C. Camargo, Hospital do Câncer. São Paulo, Brazil
BEATRIZ DE CAMARGO
Affiliation:
Pediatric Department of Centro de Tratamento e Pesquisa, Hospital A. C. Camargo, Hospital do Câncer. São Paulo, Brazil

Abstract

Objective: The aim of this study was to identify factors associated with location of death of patients receiving palliative care in a pediatric oncology unit.

Methods: A palliative care program was developed in the pediatric department in order to provide specialized attention to the patient and family in end-of-life. The program is coordinated by a nurse, delivering a simultaneous interdisciplinary team approach with focus on identification and training of a family care provider as well as local resources supplemented by support of a social worker and the community. All 87 patients in palliative care were followed by the team. The factors associated with the location of death (home or hospital) were evaluated for the 71 patients who died prior to analysis.

Results: Forty-two (59%) patients died at home. Factors significantly associated with dying at home were: male with an Odds Ratio (OR) = 3.80, 95% Confidence Interval (CI) = 1.26–11.76; public health insurance (OR) = 4.95, 95%[CI] = 1.03–26.75, low educational level of the caregiver (OR) = 11.11 95%[CI] = 1.65–94.66 and low educational level of the mother (OR) = 7.07 95%[CI] = 1.37–40.14. Gender was the only independent factor associated with location of death: a boy had a higher risk of dying at home, (OR) = 4.25, 95%[CI] = 1.37–13.21 when compared to a girl.

Significance of results: In our society we are still not able to provide hospice care or home care for all children, although increasing emphasis has been placed on utilizing local resources. Even though we had increased the number of desired home deaths, it is still a challenge to meet patients and families' requests. A team approach, the recognition of the factors involved, and adequate health and community support have helped us to meet the child and family's needs.

Type
Research Article
Copyright
© 2005 Cambridge University Press

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