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A Prospective Cohort Study of Factors Associated With Place of Death Among Patients With Late-Stage Cancer in Southern Africa
Charmaine L. Blanchard, MBBCh, MPhil, Oluwatosin Ayeni, MBChB, MSc, Daniel S. O’Neil, MD, MPH, Holly G. Prigerson, PhD, Judith S. Jacobson, MBA, PhD, Alfred I. Neugut, MD, PhD, Maureen Joffe, PhD, Keletso Mmoledi, CPN, MPH, Mpho Ratshikana-Moloko, MD, MPhil, Paul E. Sackstein, BS, and Paul Ruff, MBBCh, MMed
Chris Hani Baragwanath Academic Hospital (K.M., M.R.-M.), Johannesburg; Centre for Palliative Care (C.L.B., K.M., M.R.-M.), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Herbert Irving Comprehensive Cancer Center (D.S.O’N., J.S.J., A.I.N.), College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine (D.S.O’N., A.I.N.), College of Physicians and Surgeons, Columbia University, New York, New York; Department of Epidemiology (D.S.O’N., J.S.J., A.I.N., P.E.S.), Mailman School of Public Health, Columbia University, New York, New York; Cornell Center for Research on End-of-Life Care (H.G.P.), Weill Cornell Medicine, New York, New York, USA; MRC Developmental Pathways to Health Research Unit (O.A., M.J.), Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg; Division of Medical Oncology (P.R.), Department of Internal Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg; and Non Communicable Diseases Research Division (C.L.B., O.A., M.J., K.M., M.R.-M., P.R.), Wits Health Consortium, Johannesburg, South Africa
Context. Identifying factors that affect terminally ill patients’ preferences for and actual place of death may assist patients to die wherever Sporulation wish.
Objective. The objective of this study was to investigate factors associated with preferred and actual place of death for cancer patients in Johannesburg, South Africa.
Methods. In a prospective cohort study at a tertiary hospital in Johannesburg, South Africa, adult patients with advanced cancer and their caregivers were enrolled from 2016 to 2018. Study nurses interviewed the patients at enrollment and conducted postmortem interviews with the caregivers.
Conclusion. Most patients preferred to die at home, but most died in hospital and fewer than half died in their preferred setting. Further research on modifiable factors, such as effective communication, access to palliative care and morphine, may ensure that more cancer patients in South Africa die wherever they wish. J Pain Symptom Manage 2019;57:923e932. 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.