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Predictors for place of death among children:A systematic review and meta-analyses of recent literature

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Abstract

Through a systematic review and meta-analyses, we aimed to determine predictors for place of death among children. We searched online databases for studies published between 2008 and 2019 comprising original quantitative data on predictors for place of death among children. Data regarding study design, population characteristics and results were extracted from each study. Meta-analyses were conducted using generic inverse variance method with random effects. Fourteen cohort studies met the inclusion criteria, comprising data on 106,788 decedents. Proportions of home death varied between countries and regions from 7% to 45%. Lower age was associated with higher odds of hospital death in eight studies (meta-analysis was not possible). Children categorised as non-white were less likely to die at home compared to white (pooled OR 0.6; 95% CI 0.5–0.7) as were children of low socio-economic position versus high (pooled OR 0.7; 95% CI 0.6–0.9). Compared to patients with cancer, children with non-cancer diagnoses had lower odds of home death (pooled OR 0.5; 95% CI 0.5–0.5).

Conclusion: Country and region of residence, older age of the child, high socio-economic position, ‘white’ ethnicity and cancer diagnoses appear to be independent predictors of home death among children.

What is Known:

Home is often considered an indicator of quality in end-of-life care.

Most terminally ill children die in hospitals.

What is New:

Through a systematic review and meta-analyses, this study examined predictors for place of death among children.

• Country and region of residence, older age of the child, high socio-economic position, white ethnicity and having a cancer diagnosis appear to be independent predictors of home death among terminally ill children.

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References

  1. WHO | WHO Definition of Palliative Care. WHO.

  2. Field MJ, Behrman RE. When children die: improving palliative and end-of-life care for children and their families. Committee on palliative and end-of-life care for children and their families. 2003; 712: 0–309.

  3. End of life care for infants, children and young people young people, https://www.nice.org.uk/guidance/qs160/resources/end-of-life-care-for-infants-children-and-young-people-pdf-75545593722565 (2017, accessed 18 June 2018).

  4. The EAPC Taskforce for Palliative Care in Children. Palliative care for infants children and young people the facts: a document for healthcare professionals and policy makers.

  5. Håkanson C, Öhlén J, Kreicbergs U, Cardenas-Turanzas M, Wilson DM, Loucka M, Frache S, Giovannetti L, Naylor W, Rhee YJ, Ramos MR, Teno J, Beernaert K, Deliens L, Houttekier D, Cohen J (2017) Place of death of children with complex chronic conditions: cross-national study of 11 countries. Eur J Pediatr 176:327–335

    PubMed  Google Scholar 

  6. Hammes BJ, Klevan J, Kempf M, Williams MS (2005) Pediatric advance care planning. J Palliat Med 8:766–773

    PubMed  Google Scholar 

  7. Linton JM, Feudtner C (2008) What accounts for differences or disparities in pediatric palliative and end-of-life care? A systematic review focusing on possible multilevel mechanisms. Pediatrics 122:574–582

    PubMed  Google Scholar 

  8. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100

    PubMed  PubMed Central  Google Scholar 

  9. Wells G, Shea B, O’Connell D, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.

  10. Newcastle-Ottawa-quality assessment scale, http://www.ohri.ca/programs/clinical_epidemiology/nosgen.pdf (accessed 2 February 2018).

  11. Deeks JJ, Altman DG, Bradburn MJ Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Systematic reviews in health care. BMJ Publishing Group, London, UK, pp 285–312

  12. RevMan 5.3 User Guide, http://community.cochrane.org/sites/default/files/uploads/inline-files/RevMan_5.3_User_Guide.pdf (accessed 11 June 2018).

  13. Higgins J (2011) Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration:2–3

  14. Neergaard MA, Jensen AB, Sokolowski I, Olesen F, Vedsted P (2012) Socioeconomic position and place of death of cancer patients. BMJ Support Palliat Care 2:133–139

    PubMed  Google Scholar 

  15. Miesfeldt S, Murray K, Lucas L, Chang CH, Goodman D, Morden NE (2012) Association of age, gender, and race with intensity of end-of-life care for Medicare beneficiaries with cancer. J Palliat Med 15:548–554

    PubMed  PubMed Central  Google Scholar 

  16. Mack JW, Chen K, Boscoe FP, Gesten FC, Roohan PJ, Schymura MJ, Schrag D (2015) High intensity of end-of-life care among adolescent and young adult cancer patients in the New York State Medicaid Program. Med Care 53:1018–1026

    PubMed  PubMed Central  Google Scholar 

  17. Neergaard MA, Jensen AB, Olesen F, Vedsted P (2013) Access to outreach specialist palliative care teams among cancer patients in Denmark. J Palliat Med 16:951–957

    PubMed  Google Scholar 

  18. Rhodes RL, Xuan L, Paulk ME, Stieglitz H, Halm EA (2013) An examination of end-of-life care in a safety net hospital system: a decade in review. J Health Care Poor Underserved 24:1666–1675

    PubMed  PubMed Central  Google Scholar 

  19. Barnato AE, Cohen ED, Mistovich KA et al (2015) Hospital end-of-life treatment intensity among cancer and non-cancer cohorts. J Pain Symptom Manage 49:521-9.e1–5

    PubMed  Google Scholar 

  20. Pivodic L, Pardon K, Morin L, Addington-Hall J, Miccinesi G, Cardenas-Turanzas M, Onwuteaka-Philipsen B, Naylor W, Ruiz Ramos M, van den Block L, Wilson DM, Loucka M, Csikos A, Rhee YJ, Teno J, Deliens L, Houttekier D, Cohen J, EURO IMPACT (2016) Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries. J Epidemiol Community Health 70:17–24

    PubMed  Google Scholar 

  21. Öhlén J, Cohen J, Håkanson C (2017) Determinants in the place of death for people with different cancer types: a national population-based study. Acta Oncol 56:455–461

    PubMed  Google Scholar 

  22. Rajeshuni N, Johnston EE, Saynina O, Sanders LM, Chamberlain LJ (2017) Disparities in location of death of adolescents and young adults with cancer: a longitudinal, population study in California. Cancer 123:4178–4184

    PubMed  Google Scholar 

  23. Decourcey DD, Silverman M, Oladunjoye A et al (2017) Patterns of care at the end of life for children and young adults with life-threatening complex chronic conditions. J Pediatr 193:196-203.e2

    PubMed  PubMed Central  Google Scholar 

  24. Thienprayoon R, Lee SC, Leonard D, Winick N (2013) Racial and ethnic differences in hospice enrollment among children with cancer. Pediatr Blood Cancer 60:1662–1666

    PubMed  Google Scholar 

  25. Colvin JD, Zaniletti I, Fieldston ES, Gottlieb LM, Raphael JL, Hall M, Cowden JD, Shah SS (2013) Socioeconomic status and in-hospital pediatric mortality. Pediatrics 131:e182–e190

    PubMed  Google Scholar 

  26. Ananth P, Melvin P, Feudtner C, Wolfe J, Berry JG (2015) Hospital use in the last year of life for children with life-threatening complex chronic conditions. Pediatrics 136:938–946

    PubMed  PubMed Central  Google Scholar 

  27. Bender HU, Riester MB, Borasio GD, Führer M (2017) Let’s bring her home first. Patient characteristics and place of death in specialized pediatric palliative home care. J Pain Symptom Manage 54:159–166

    PubMed  Google Scholar 

  28. Dussel V, Kreicbergs U, Hilden JM, Watterson J, Moore C, Turner BG, Weeks JC, Wolfe J (2009) Looking beyond where children die: determinants and effects of planning a child’s location of death. J Pain Symptom Manage 37:33–43

    PubMed  Google Scholar 

  29. Lykke C, Ekholm O, Schmiegelow K, Olsen M, Sjøgren P (2018) All-cause mortality rates and home deaths decreased in children with life-limiting diagnoses in Denmark between 1994 and 2014. Acta Paediatr 107:1781–1785

    PubMed  Google Scholar 

  30. Niswander LM, Cromwell P, Chirico J, Gupton A, Korones DN (2014) End-of-life care for children enrolled in a community-based pediatric palliative care program. J Palliat Med 17:589–591

    PubMed  Google Scholar 

  31. Price J, Willcox M, Kabudula CW et al (2019) Home deaths of children under 5 years in rural South Africa: a population-based longitudinal study. Trop Med Int Heal 24:862–878

    Google Scholar 

  32. Siden H, Miller M, Straatman L, Omesi L, Tucker T, Collins JJ (2008) A report on location of death in paediatric palliative care between home, hospice and hospital. Palliat Med 22:831–834

    CAS  PubMed  Google Scholar 

  33. Gao W, Verne J, Peacock J, Stiller C, Wells C, Greenough A, Higginson IJ (2016) Place of death in children and young people with cancer and implications for end of life care: a population-based study in England, 1993-2014. BMC Cancer 16:727

    PubMed  PubMed Central  Google Scholar 

  34. Shah A, Diggens N, Stiller C, Murphy D, Passmore J, Murphy MFG (2011) Place of death and hospital care for children who died of cancer in England, 1999–2006. Eur J Cancer 47:2175–2181

    PubMed  Google Scholar 

  35. Kassam A, Sutradhar R, Widger K, Rapoport A, Pole JD, Nelson K, Wolfe J, Earle CC, Gupta S (2017) Predictors of and trends in high-intensity end-of-life care among children with cancer: a population-based study using health services data. J Clin Oncol 35:236–242

    PubMed  Google Scholar 

  36. Forjaz de Lacerda A, Gomes B (2017) Trends in cause and place of death for children in Portugal (a European country with no paediatric palliative care) during 1987–2011: A population-based study. BMC Pediatr 17:1–11

    Google Scholar 

  37. Pousset G, Bilsen J, Cohen J, Addington-Hall J, Miccinesi G, Onwuteaka-Philipsen B, Kaasa S, Mortier F, Deliens L (2010) Deaths of children occurring at home in six European countries. Child Care Health Dev. Epub ahead of print 36:375–384. https://doi.org/10.1111/j.1365-2214.2009.01028.x

    Article  CAS  PubMed  Google Scholar 

  38. Cawkwell PB, Gardner SL, Weitzman M (2015) Persistent racial and ethnic differences in location of death for children with cancer. Pediatr Blood Cancer 62:1403–1408

    PubMed  Google Scholar 

  39. Hung YN, Liu TW, Tang ST (2015) Determinants of hospital death for Taiwanese pediatric cancer decedents, 2001–2010. J Pain Symptom Manage 50:685–692

    PubMed  Google Scholar 

  40. Cárdenas-Turanzas M, Tovalín-Ahumada H, Carrillo MT, Paéz-Aguirre S, Elting L (2008) The place of death of children with cancer in the metropolitan areas of Mexico. J Palliat Med 11:973–979

    PubMed  Google Scholar 

  41. Johnston EE, Alvarez E, Saynina O, Sanders L, Bhatia S, Chamberlain LJ (2017) Disparities in the intensity of end-of-life care for children with cancer. Pediatrics 140:e20170671

    PubMed  Google Scholar 

  42. Kaye EC, DeMarsh S, Gushue CA, Jerkins J, Sykes A, Lu Z, Snaman JM, Blazin LJ, Johnson LM, Levine DR, Morrison RR, Baker JN (2018) Predictors of location of death for children with cancer enrolled on a palliative care service. Oncologist 23:1525–1532

    PubMed  PubMed Central  Google Scholar 

  43. Fraser LK, Fleming S, Parslow R (2018) Changing place of death in children who died after discharge from paediatric intensive care units: a national, data linkage study. Palliat Med 32:337–346

    PubMed  Google Scholar 

  44. Rost M, Wangmo T, Rakic M, Acheson E, Rischewski J, Hengartner H, Kühne T, Elger BS (2018) Burden of treatment in the face of childhood cancer: a quantitative study using medical records of deceased children. Eur J Cancer Care (Engl) 27:e12879

    Google Scholar 

  45. Heterogeneity and subgroup analyses in Cochrane Consumers and Communication Group reviews: Planning the analysis at protocol stage.

  46. Sullivan J, Gillam L, Monagle P (2015) Parents and end-of-life decision-making for their child: roles and responsibilities. BMJ Support Palliat Care 5:240–248

    PubMed  Google Scholar 

  47. Ullrich C, Morrison RS (2013) Notes from the Editor Pediatric palliative care research comes of age: what we stand to learn from children with life-threatening illness. https://doi.org/10.1089/jpm.2013.9518

  48. Bostwick D, Wolf S, Samsa G, Bull J, Taylor DH Jr, Johnson KS, Kamal AH (2017) Comparing the palliative care needs of those with cancer to those with common non-cancer serious illness. Epub ahead of print 53:1079–1084.e1. https://doi.org/10.1016/j.jpainsymman.2017.02.014

    Article  Google Scholar 

  49. Luddington L, Cox S, Higginson I, Livesley B (2001) The need for palliative care for patients with non-cancer diseases: a review of the evidence. Int J Palliat Nurs 7:221–226

    CAS  PubMed  Google Scholar 

  50. Association for Palliative Medicine of Great Britain and Ireland, Consultant Nurse in Palliative Care Reference Group, Marie Curie Cancer Care, et al. Commissioning guidance for specialist palliative care: helping to deliver commissioning objectives.

  51. Cochrane H, Liyanage S, Nantambi R. Palliative care statistics for children and young adults: health and care partnerships analysis. 2007.

    Google Scholar 

  52. Fairley L, Cabieses B, Small N, Petherick ES, Lawlor DA, Pickett KE, Wright J (2014) Using latent class analysis to develop a model of the relationship between socioeconomic position and ethnicity: cross-sectional analyses from a multi-ethnic birth cohort study. BMC Public Health 14:835

    PubMed  PubMed Central  Google Scholar 

  53. Dreyer B, Chung PJ, Szilagyi P, Wong S (2016) Child poverty in the United States today: introduction and executive summary. Acad Pediatr 16:S1–S5

    PubMed  Google Scholar 

  54. World Health Organisation. Closing the gap in a generation: health equity through action on the social determinants of health. Commission on Social Determinants of Health. 2008.

  55. Gisquet E, Julliard S, Geoffroy-Perez B (2015) Do social factors affect the place of death? Analysis of home versus institutional death over 20 years. J Public Health (Bangkok) 38:fdv167

    Google Scholar 

  56. Higginson IJ, Jarman B, Astin P, Dolan S (1999) Do social factors affect where patients die: an analysis of 10 years of cancer deaths in England. J Public Health Med 21:22–28

    CAS  PubMed  Google Scholar 

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Acknowledgements

We highly appreciate the support from Marianne Godt Hansen on language revision for this article.

Funding

This work was supported by M.L. Jørgensen og Gunnar Hansens Fond (the authors declare that they have no other financial relationship with this organisation).

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Authors and Affiliations

Authors

Contributions

S.L.W. conceptualised and designed the study, conducted literature searches, study selections and data extractions, and drafted the initial manuscript.

M.A.N. conceptualised and designed the study, conducted literature searches, study selections and data extractions, and reviewed and revised the manuscript.

C.F.C., M.K.N., S.P.J. and H.S. conceptualised and designed the study, reviewed and revised the manuscript.

All authors have approved the final manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sanne Lausen Wolff.

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The authors declare that they have no competing interests.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Communicated by Gregorio Paolo Milani

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Wolff, S.L., Christiansen, C.F., Nielsen, M.K. et al. Predictors for place of death among children:A systematic review and meta-analyses of recent literature. Eur J Pediatr 179, 1227–1238 (2020). https://doi.org/10.1007/s00431-020-03689-2

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