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Open Access Research article

Age, gender, will, and use of home-visit nursing care are critical factors in home care for malignant diseases; a retrospective study involving 346 patients in Japan

Yuko Kodama12*, Tomoko Matsumura1, Takuhiro Yamaguchi3, Morihito Takita1, Shohei Kawagoe3, Yukihiro Kimura4, Satoshi Hirahara5, Hiroshi Suzuki6, Hideki Ohta7, Shigeru Onozawa8, Tadashi Wada3, Yukiyasu Nakamura9, Kazushi Nakano10, Masahiro Kami1 and Koichiro Yuji11

Author Affiliations

1 Division of Social Communication System for Advanced Clinical Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan

2 Clinical Data Management Division, The University of Tokyo, Tokyo, Japan

3 Aozora Medical Clinic, Chiba, Japan

4 Morioka Home Care Clinic, Iwate, Japan

5 Kajiwara Clinic, Tokyo, Japan

6 Suzuki Clinic, Tokyo, Japan

7 Oyama -johoku Clinic, Tochigi, Japan

8 Departments of Family Medicine, Kameda Medical Center, Chiba, Japan

9 Hinode Clinic, Fukuoka, Japan

10 Nakano Home Care Clinic, Kagoshima, Japan

11 Department of Internal Medicine, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan

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BMC Palliative Care 2011, 10:17  doi:10.1186/1472-684X-10-17

Published: 1 November 2011

Abstract

Background

We aimed to clarify the factors affecting outcomes of home care for patients with malignant diseases.

Methods

Of 607 patients who were treated in 10 clinics specialized in home care between January and December 2007 at Chiba, Fukuoka, Iwate, Kagoshima, Tochigi and Tokyo prefectures across Japan, 346 (57%; 145 men and 201 women) had malignant diseases. We collected information on medical and social backgrounds, details of home care, and its outcomes based on their medical records.

Results

Median age of the patients was 77 years (range, 11-102), and 335 patients were economically self-sufficient. Their general condition was poor; advanced cancer (n = 308), performance status of 3-4 (n = 261), and dementia (n = 121). At the beginning of home care, 143 patients and 174 family members expressed their wish to die at home. All the patients received supportive treatments including fluid replacement and oxygenation. Median duration of home care was 47 days (range, 0-2,712). 224 patients died at home. For the remaining 122, home care was terminated due to complications (n = 109), change of attending physicians (n = 8), and others (n = 5). The factors which inhibited the continuity of home care were the non-use of home-visit nursing care (hazard ratio [HR] = 1.78, 95% confidence interval [CI]: 1.05-3.00, p = 0.03), the fact that the patients themselves do not wish to die at home (HR = 1.83, CI: 1.09-3.07, p = 0.02), women (HR = 1.81, CI: 1.11-2.94, p = 0.02), and age (HR = 0.98, CI: 0.97-1.00, p = 0.02).

Conclusions

Continuation of home care is influenced by patients' age, gender, will, and use of home-visit nursing.

Keywords:
palliative medicine; cancer; dementia; complication; performance status