Advance care planning and home death in patients with advanced cancer: a structured interview analysis

Discrepancy between preferred and actual place of death is common in patients with advanced cancer.

To investigate the association between advance care planning (ACP) and home death in patients with advanced cancer.

Using structured interviews, 44 primary nurses from 19 home-visit nursing agencies in Japan were asked about status changes for 123 advanced cancer patients receiving home care. The main outcome was the place of death.

Of the 123 patients, 16 were alive, 54 died at home and 53 died at hospital. Multivariate analyses revealed that home death was more likely if: i) physicians or nurses practised ACP during the whole home-visit period (odds ratio (OR) 41.76; confidence interval (CI) 5.87-297.07); ii) patients had adequate insight concerning their prognosis just before death or at hospitalisation (OR 7.85; CI 1.18-52.24); and iii) the baseline preference of families was a home death (OR 0.09; 95% CI 0.01-0.73).

ACP practiced by physicians or nurses for advanced cancer patients may contribute to achieving home death.