Impact on place of death in cancer patients: a causal exploration in southern Switzerland
Abstract Background Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex netwo...
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12904-020-00664-4 |
| _version_ | 1828543614604541952 |
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| author | Heidi Kern Giorgio Corani David Huber Nicola Vermes Marco Zaffalon Marco Varini Claudia Wenzel André Fringer |
| author_facet | Heidi Kern Giorgio Corani David Huber Nicola Vermes Marco Zaffalon Marco Varini Claudia Wenzel André Fringer |
| author_sort | Heidi Kern |
| collection | DOAJ |
| description | Abstract Background Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care. Methods A data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review. Results Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family’s preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient’s preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%. Conclusion Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family’s decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested. |
| first_indexed | 2024-12-12T02:17:12Z |
| format | Article |
| id | doaj.art-a44522741cdc40869ad79aac6d245aca |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-12-12T02:17:12Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-a44522741cdc40869ad79aac6d245aca2022-12-22T00:41:47ZengBMCBMC Palliative Care1472-684X2020-10-0119111010.1186/s12904-020-00664-4Impact on place of death in cancer patients: a causal exploration in southern SwitzerlandHeidi Kern0Giorgio Corani1David Huber2Nicola Vermes3Marco Zaffalon4Marco Varini5Claudia Wenzel6André Fringer7Triangolo AssociationIDSIA, Dalle Molle Institute for Artificial IntelligenceIDSIA, Dalle Molle Institute for Artificial IntelligenceIDSIA, Dalle Molle Institute for Artificial IntelligenceIDSIA, Dalle Molle Institute for Artificial IntelligenceTriangolo AssociationDepartment Health Sciences (Institute for Therapeutic Sciences), KREMS, IMC University of Applied SciencesDepartment Health, Institute of Nursing, Zurich University of Applied Sciences ZHAWAbstract Background Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care. Methods A data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review. Results Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family’s preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient’s preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%. Conclusion Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family’s decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.http://link.springer.com/article/10.1186/s12904-020-00664-4CancerEnd-of-life carePalliative home carePlace of deathCommunicationFamily caregivers |
| spellingShingle | Heidi Kern Giorgio Corani David Huber Nicola Vermes Marco Zaffalon Marco Varini Claudia Wenzel André Fringer Impact on place of death in cancer patients: a causal exploration in southern Switzerland BMC Palliative Care Cancer End-of-life care Palliative home care Place of death Communication Family caregivers |
| title | Impact on place of death in cancer patients: a causal exploration in southern Switzerland |
| title_full | Impact on place of death in cancer patients: a causal exploration in southern Switzerland |
| title_fullStr | Impact on place of death in cancer patients: a causal exploration in southern Switzerland |
| title_full_unstemmed | Impact on place of death in cancer patients: a causal exploration in southern Switzerland |
| title_short | Impact on place of death in cancer patients: a causal exploration in southern Switzerland |
| title_sort | impact on place of death in cancer patients a causal exploration in southern switzerland |
| topic | Cancer End-of-life care Palliative home care Place of death Communication Family caregivers |
| url | http://link.springer.com/article/10.1186/s12904-020-00664-4 |
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