PCU-to-home transition sequences and final place of death in advanced cancer: a prospective Japanese cohort study of a regional electronic communication platform

Transition from a palliative care unit (PCU) to home is clinically important in advanced cancer, but the sequence from planned or attempted transition through discharge realization and final place of death is insufficiently described. Electronic communication platforms may provide process markers of regional coordination.

We conducted a single-center prospective observational cohort study of consecutive patients with advanced cancer from 2018 to 2023. Patients were included when PCU-to-home transition was planned or attempted and they were registered in a regional electronic home palliative care communication platform derived from a paper-based pathway. We descriptively examined transition sequences, final place of death, non-home death subcategories, cumulative notebook count, and notebook entries per 7 home-care days.

Among 209 planned or attempted transitions, 199 (95.2%) achieved actual home discharge and 10 (4.8%) remained unrealized. In the full cohort, home death occurred in 122 patients (58.4%) and non-home death in 87 (41.6%); 77 of 87 non-home deaths occurred in a PCU/palliative care unit. Among actual home-discharge patients, home death occurred in 122/199 (61.3%) and non-home death in 77/199 (38.7%). Median cumulative notebook counts were 23 [13-44] and 20 [10-40], respectively (descriptive P = 0.326). Median entries per 7 home-care days were 7.54 [2.62-19.76] and 5.13 [1.79-9.58] (descriptive P = 0.012).

Most planned or attempted transitions achieved actual home discharge, but final place of death diverged thereafter. Notebook count and rate were descriptive communication-process markers that may help characterize and review multidisciplinary coordination across the ongoing regional transition process after PCU discharge.