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.