Effectiveness of Multidisciplinary Pre-Discharge Conferences on Concordance Rate in Place of End-of-Life Care and Death: A Single-Center Retrospective Study

Abstract

Backgrounds: The pre-discharge conference (PDC) is crucial for ensuring care continuity based on patients’ preferences and goals. However, there is no quantitative on its effectiveness. We investigated the effectiveness of multidisciplinary PDC on the concordance rate between the preferred (PPEoLC) and actual place of end-of-life care and death. Methods: Overall, 551 older homebound patients (median age, 83.0 years; female, 49.4%; male, 50.6%) receiving continuous home medical care through clinics were enrolled in hospital ward admission from March 2011 to September 2018. Patient demographics, presence or absence of PDCs, statements from patients and their families regarding PPEoLC, and place of death of deceased patients were confirmed from the patients’ medical records, followed by concordance rate analyses between PPEoLC and place of death and a multivariate analysis of home mortality. We used the Mann–Whiney U test to assess attribute data, hypothesis testing to assess the difference in the population proportions, and binominal logistic regression analyses to evaluate the relationship between valuables. Results: In the conference group, the home mortality rate, patients’ and their families’ expression rates, and preferences for their home of PPEoLC were higher (p < 0.001) than those in the non-conference group. The place of death was significantly influenced by family preferences. Conclusions: PDC can affect the place of death of homebound patients, but family preferences rather than patient preferences influence the decision of the patient’s place of death. To better reflect the patient preferences, patient-centered decision support should be provided earlier in the disease process.