Factors Influencing Home Death in a Japanese Metropolitan Region

To examine factors influencing home death, an anonymous survey was mailed to 998 home care supporting clinics (HCSCs) in the 23 wards of Tokyo, Japan. We classified the HCSCs into two types (single physician practice and multiple physician practice) and identified factors of each type of practice that predict home death. The factors associated with a greater probability of dying at home were as follows: in the multiple physician practices, collaboration with hospitals and teaching coping skills to the family members and, in the single physician practices, collaboration with clinics. Our findings suggest that home end-of-life care services are unlikely to be achieved without cooperation among service providers and without improvement of the family members' coping skills. 1. Introduction For Japanese people the preferred place of death has usually been home [1, 2]. A 12.3% of home death has been recorded for the year 2007 [3]. Miyata et al. suggested that end-of-life care and home death was not a very practical option in Japan because the quality of home care was not satisfactory until recently [4]. Previous studies have also observed that patients prefer end-of-life and death to happen at home; however this preference is not often recorded as an actual place of death [5–9]. Steinhauser et al. have indicated that many people prefer to die at home, but, primarily, there are other important factors which need to be addressed before consideration of home death including pain and symptom management, preparation for death, achieving a sense of completion, decisions about treatment preferences, and being treated as a “whole person” [8]. Beccaro et al. emphasized that policy makers should encourage health services to focus on ways of meeting individual preferred places of death [9]. Previous studies have found that certain features of the home care system are associated with place of death [10–13]. For instance, home visit by general practitioners (GPs) is a factor that contributes to high incidence of home death [10]. Fukui et al. [11] reported that the number of home visits per week by home care nurses influenced the incidence of home death. Grande et al. [12] reported that the commonly mentioned factors in care evaluations by GPs and district nurses were their accessibility, enlistment of support from other agencies, and their ability to ensure the availability of equipment and supplies. Rosenquist et al. [13] mentioned that a key factor for the success of home care is the availability of a GP and nurses, as well as an access to hospital bed as and when