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Development of a Clinical Tool to Predict Home Death of a Discharged Cancer Patient in Japan: a Case-Control Study

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Abstract

Purpose

The aim of this study was to investigate the predictive value of a clinical tool to predict whether discharged cancer patients die at home, comparing groups of case who died at home and control who died in hospitals or other facilities.

Method

We conducted a nationwide case-control study to identify the determinants of home death for a discharged cancer patient. We randomly selected nurses in charge of 2000 home-visit nursing agencies from all 5813 agencies in Japan by referring to the nationwide databases in January 2013. The nurses were asked to report variables of their patients’ place of death, patients’ and caregivers’ clinical statuses, and their preferences for home death. We used logistic regression analysis and developed a clinical tool to accurately predict it and investigated their predictive values.

Results

We identified 466 case and 478 control patients. Five predictive variables of home death were obtained: patients’ and caregivers’ preferences for home death [OR (95% CI) 2.66 (1.99–3.55)], availability of visiting physicians [2.13 (1.67–2.70)], 24-h contact between physicians and nurses [1.68 (1.30–2.18)], caregivers’ experiences of deathwatch at home [1.41 (1.13–1.75)], and patients’ insights as to their own prognosis [1.23 (1.02–1.50)]. We calculated the scores predicting home death for each variable (range 6–28). When using a cutoff point of 16, home death was predicted with a sensitivity of 0.72 and a specificity of 0.81 with the Harrell’s c-statistic of 0.84.

Conclusion

This simple clinical tool for healthcare professionals can help predict whether a discharged patient is likely to die at home.

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Acknowledgements

We thank the home-visiting nurses for their generous cooperation in this study. We are also grateful to Dr. Hiroya Kinoshita, Dr. Junko Fujita, Dr. Yuko Okamoto, and Dr. Yoshiki Ishikawa for their research advices. We also thank Ms. Eiko Kawano, Mr. Toshiya Saito, Mr. Daitaro Misawa, Mr. Oosono Yasufumi, Ms. Takako Ishikawa, Ms. Yumi Yokota, and Ms. Kumi Kaifu for their research assistance.

Contributorship Statement

All authors formulated the study design. SF and KY carried out the statistical analyses. SF wrote the first and successive drafts of the paper. All authors interpreted the results, revised the text for important intellectual content, and approved the final draft of the report.

Author information

Authors and Affiliations

  1. Department of Community Health Nursing, Graduate School of Nursing, The Japanese Red Cross University, 4-1-3 Hiroo, Shibuya-ku, Tokyo, 150-0012, Japan

    Sakiko Fukui

  2. Seirei Hospice, Seirei Mikatabara Hospital, Hamamatsu, Shizuoka, Japan

    Tatsuya Morita

  3. Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan

    Kazuhiro Yoshiuchi

Authors
  1. Sakiko Fukui
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  3. Kazuhiro Yoshiuchi
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Corresponding author

Correspondence to Sakiko Fukui.

Ethics declarations

Funding

This study was funded by a Health and Labor Science Research Grant, Ministry of Health, Labor and Welfare, the Japanese Government (No. H26-51). The funding sources were involved neither in the conduct of the research nor in the preparation of the article.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

Ethics approval for this study was obtained from the Institutional Review Board of The Japanese Red Cross College of Nursing (No.2012-80). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Research Involving Human Participants and Informed Consent

Questionnaires were distributed to 2000 home-visit nursing agencies, which were randomly selected from all of 5813 agencies by referring to the nationwide databases, with a cover letter explaining the survey and requesting completion of the questions about eligible patients with the instruction to complete the questionnaire. Ethics approval for this study was obtained from the Institutional Review Board of The Japanese Red Cross College of Nursing (No.2012-80).

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Fukui, S., Morita, T. & Yoshiuchi, K. Development of a Clinical Tool to Predict Home Death of a Discharged Cancer Patient in Japan: a Case-Control Study. Int.J. Behav. Med. 24, 584–592 (2017). https://doi.org/10.1007/s12529-016-9619-y

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