Social Factors Affecting Home-Based End-of-Life Care for Patients with Cancer and Primary Caregivers

Abstract

Objective This study explored how the economic and social circumstances of patients' and their caregivers influenced home-based care. Methods A secondary analysis was conducted using the dataset (home-based end-of-life care N = 625, hospital end-of-life care N = 7603) Comprehensive patient-based survey conducted by The Study on Quality Evaluation of Hospice and Palliative Care by Bereaved Caregivers (J-HOPE 4), and multivariate analysis (multiple logistic regression) to explore the impact of social factors of patients and caregivers on the success of home-based end-of-life care. The main objective of the analysis was to examine the social factors in home-based end-of-life care, with hospital care as a control. The explanatory variables included 11 social factors of patients, such as age and sex, and 18 social factors of primary caregivers. Results For patients with medical expenses less than 100,000 yen (Odds ratio: OR 2.06), household income of 4 million yen or more (OR 0.67), preferences for home care (OR 1.49), preferences to die at home (OR 1.58), wish to die at home (OR 1.52), and lack of patient’s financial well-being (OR 0.72) were significant factors associated with home-based end-of-life care. Significant factors for caregivers included male caregivers (OR 0.66), poor mental state (OR 0.79), ability to provide daily care (OR 3.02), experience of caring for a deceased family member (OR 0.66), presence of alternative caregivers (OR 0.78), and cohabitation with caregivers (OR 1.47). Conclusion Patient preferences, social situations, primary caregivers' social situations, and mental states influenced home-based end-of-life care.