Abstract CN10
Background
The literature reviewed show discord between the preferences of place of death expressed by people in Palliative Care and the actual place of death. It is necessary to analyze this situation, highlighting the importance of the wishes and preferences of patients and their caregivers.
Methods
Study design: longitudinal, prospective single-cohort, analytical. 427 people were studied in 2018 in the Bahia de Cadiz-La Janda District (Andalusia, Spain). Among other variables, this investigation studied the preferences of place of death expressed by the patient and their caregiver (home, hospital or undefined) during the initial evaluation (IE) and Last Days and Hours of Life (LDHL), as well as the actual place of death (home or hospital).
Results
52.2% of patients died at home and 47.8% died in the hospital. The place preferred by patients and caregivers is home, which is the case both at the time of the IE (Patient: 36.5% home, 11.8% hospital and 51.8% undefined; Caregiver: 40.3%, 21.3% and 38.4%) and LDHL (Patient: 41.9%, 15.9% and 42.2%; Caregiver: 51.2%, 32.0% and 16.8%). (See Table) A significant association is found (p<0.05) between the preference stated during IE and during LDHL and the actual place of death, both for the patient (59.5% and 81.3% congruence, respectively) and the caregiver (68.9% and 87.7%). This relationship is more intense in the case of the wishes expressed during LDHL, both by the patient (59.9% vs 81.3%) and the caregiver (68.9% vs 87.7%), and more intense in the case of the caregiver’s preference (87.7%) than that of the patient (81.3%). Table: CN10
Congruence between actual and preferred place of death by patient and caregiver at time of initial evaluation (IE) and last days and hours of life (LDHL)
| General congruence | Sig. | Kappa | Sig. | |
| Patient at IE | 59,5% | p <0,034 | 0,150 | p = 0,017 |
| Caregiver at IE | 68,9% | p <0,001 | 0.357 | p <0,001 |
| Patient in LDHL | 81,3% | p <0,001 | 0,600 | p <0,001 |
| Caregiver in LDHL | 87,7% | p <0,001 | 0,746 | p <0,001 |
Conclusions
There is a significant relationship/congruence between the actual and preferred place of death by patients and caregivers. This relationship is stronger in the case of preferences during LDHL and for caregivers, which must be taken into consideration when planning care prior to death.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Biomedical Research Management Foundation of Cádiz (INiBICA). Project subsidized within the framework of the Integrated Territorial Initiative (ITI) 2014-2020 for Cádiz by the Andalusian Consejería de Salud and by the European Regional Development Fund (FEDER)
Disclosure
All authors have declared no conflicts of interest.