Authors (including presenting author) :
Ip HTJ(1), Chan PCS(2), Kwok WLA(3), Lee YTK(1), Mak MYM(1)
Affiliation :
(1) Physiotherapy Department, Tuen Mun Hospital
(2) Clinical Oncology Department, Tuen Mun Hospital
(3) The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong
Introduction :
Enabling patients to decide their place of death has been rated as highly important by terminally ill patients. Despite the global uprising trend of home death rate, the majority of deaths in Hong Kong remained in the hospital. Evaluation on advanced cancer patients’ and their caregivers’ preference of dying at home would provide insights on future dying in place planning with culturally sensitive considerations.
Objectives :
The primary objectives were to explore preference for dying at home and identify determinants affecting home death preference. The secondary objectives were to explore the impact of cultural beliefs on home death preference and investigate facilitating and obstructing factors of congruence of home death preference.
Methodology :
10 subjects with advanced cancer and 7 corresponding caregivers were recruited from the palliative care ward in Tuen Mun Hospital via purposive and quota sampling. Pre-interview questionnaires and semi-structured interviews were conducted to collect information on preference of dying at home and its determinants, comments on cultural beliefs and congruence of preference. All data were transcribed verbatim and analyzed by inductive thematic analysis.
Result & Outcome :
Results:
4 subjects and 2 corresponding caregivers preferred dying at home. The determinants of dying at home preference could be categorized into individual factors, social support, cultural beliefs, macrosocial factors, and healthcare input. Among which, findings showed that comfortability and company of friends and families were the main drivers of home death preference, while caregiver availability, home environment readiness, strong belief in medical authority were the potential negative determinants. Moreover, lacking discussion about place of death was identified in over half of the subject-caregiver pairs which might further hinder congruence of preference and preference actualisation.
Conclusions:
Preference of dying at home should not be underrated. Considering the possible spur to improve the quality of death and relieve healthcare financial burden, more effort should be allocated to make caring and dying outside hospital possible. Apart from removing legal and operational barriers, concurrent focus at socio-cultural level is important for actualizing home death preference. Enhancement work in supporting caregivers, promoting home environment readiness and advancing public life and death education has to be implemented to create a supportive environment for future dying in place planning.
