Determinants of home versus hospital terminal care for patients with gynecologic cancer

Background. This study reviewed all patients managed by the Gynecologic Oncology service of a tertiary care facility (n = 468) whose deaths occurred between 1980 and 1990 to ascertain the site of death and potential factors affecting whether patients died at home or in a hospital. Methods. Gynecologic Oncology Tumor Registry data were analyzed for patient diagnosis, age at diagnosis, age at death, marital status, insurance coverage, and year of death in relation to location of death. Results. This study found that 78% of patients died in the hospital, and 22% died at home. The mean terminal hospital stay was 15 days. The variables examined in this study could only accurately predict location of death in 59% of the cases. Examination of the variable year of death, however, demonstrated that the likelihood of death in the hospital generally increased from 1980 to 1990, despite introduction of diagnosis related groups and aggressive efforts by caregivers to facilitate and encourage death at home. Conclusions. Philosophical and economic considerations to the contrary, a significant majority of terminal patients with gynecologic cancers will die in a hospital, thus extensively utilizing our limited health resources.