Factors related to the quality of death and family satisfaction among cancer patients at home: an analysis using death certificate data and a national bereaved family survey.

PURPOSE: Ensuring a high quality of death (QOD) and family satisfaction is crucial for advanced cancer patients receiving home-based care. While home deaths are associated with better QOD and family satisfaction, key contributing factors remain unclear. This study aimed to identify key factors of QOD and family satisfaction among cancer patients at home using a nationwide mortality follow-back survey and bereavement questionnaire.

METHODS

A secondary analysis of a nationwide, cross-sectional mortality follow-back survey was conducted. Data were collected from bereaved family members of cancer patients who died at home in 2017-2018. The primary outcomes were QOD in the last month of life, assessed via the Good Death Inventory (GDI), and family satisfaction at the last place before death. Multivariate regression analyses examined associations between QOD, family satisfaction, and factors such as medical and nursing care, end-of-life (EOL) discussions, and caregiver burden.

RESULTS

Among 30,205 surveyed families, 18,505 responded (61.3%). Adequate patient-physician discussions on the place of death were positively associated with GDI and family satisfaction (β = 6.22, p < 0.001; OR = 2.69, p < 0.001), as were regular physician home visits (β = 1.57, p < 0.001; OR = 1.58, p < 0.001). Conversely, ambulance use (β = - 1.68, p < 0.001; OR = 0.69, p < 0.001) and caregiver burden (β = - 3.06, p < 0.001; OR = 0.85, p < 0.001) were negatively associated with both outcomes.

CONCLUSION

Regular physician visits and EOL discussions significantly positively associated with QOD and family satisfaction. Minimizing caregiver burden and avoiding ambulance use may further enhance QOD and family satisfaction at home.