Factors associated with preferences for place of terminal care and death among cancer patients at King Chulalongkorn Memorial Hospital.

Abstract

Background : Although patients’ needs are the main concerns in the end-of-life care, sometimes medical personnel cannot recognize the patients’ true desires. Since Thai cultures and beliefs discourage a discussion on death and dying including places of death, patients may not receive their desired terminal care.

Objective : To determine the preferences and the influencing factors for a place of terminal care and of death among cancer patients at King Chulalongkorn Memorial Hospital.

Methods : A cross-sectional descriptive study was carried out at the Department of Radiotherapy, on both in-patient and out-patient units from March to June 2012. A questionnaire with interview was used to, obtained data that was analyzed with univariate analysis and binary logistic regression.

Results : Ninety-six patients were recruited into the study. As for the place of terminal care, 57 patients (59.4%) preferred a private place (e.g. home), while 35 patients (36.5%) chose a health care institute. As for the place of death, 58 patients (60.4%) chose a private place, and 33 patients (34.4%) an institute. The influencing factors on decision making included the need of medical treatment, privacy, opportunity to be with loved ones, fear of night symptoms, safety, and sense of control. Current residential area was the only demographic factor that showed an association with the preference.

Conclusion : Majority of the patients desired to be taken care of and to die at home, especially those living in the rural areas. Yet, more than one-third of the patients preferred a health care institute. The medical team should be able to provide different services to accommodate different needs for each individuals and communities.