Introduction: Dying at home and remaining at home as long as possible are of great importance to a majority of seriously ill cancer patients and their families. However, only a minority of patients actually dies at home in most Western countries. Factors influencing place of death in unselected populations are not fully understood. More specially, there is lack of assessment of the influence of non-specialised community services.
Aim: to explore whether general practitioners and community nurse services had an impact on place of death when adjusted for patient related factors.
Methods: Cohort study based on data linkage from six Danish registers. All patients who had died due to cancer in the County of Funen between 1 January 1996 and 31 December 1998 were identified.Data of general practice activity, community nurse activity, date and type of admissions, ambulatory contacts and operations were collected.
Results: General practitioners' home visits had a highly significant impact on home death (adjusted odds ratio 11.8 (95% confidence interval 8.3 to 16.8)). Also, community nurses visiting the home had an impact (2.8 (2.1 to 3.8)). Furthermore, dying at home was associated with marital status: 1.4 (1.2 to 1.8) while it was inversely associated with survival time less than 1 month: 0.4 (0.3 to 0.6). Types of cancer, gender, age or residence were not predictive of a home death in this multivariate analysis.
Conclusion: Involving general practitioners and community nurses in the organisation of late- stage cancer care and encouraging them to make home visits could be an important tool for achieving the goal of the majority of late-stage cancer patients: To remain at home and to die at home provided that the necessary aid is available.