Background/Objectives: The place where a person dies serves as an indicator of end-of-life care quality. This study aims to identify the congruence of place of death (POD) and the reasons behind decision-making among terminally ill cancer patients in East Asia.Methods: We conducted a prospective multicenter cohort study in palliative care units in Japan, Korea, and Taiwan. Data were collected by the responsible physicians during routine clinical practice. Sankey diagrams were applied to present changes in reasons for POD incongruence.Results: A total of 2638 participants from 37 palliative care units in the three countries were enrolled, and most of them died at PCUs (Japan: 95.7%, Korea: 94%, Taiwan: 82%,p< 0.05). The congruence rate of the preferred and actual POD among PCU inpatients ranged from 70% to 80%. Availability of end-of-life care is the most common reason for preferred and eventual PCU death (78.6%, 72.2%, and 52.1%, respectively,p< 0.05). However, 13–22% of patients admitted to PCUs still preferred to die at home, for which traditional culture (20.2%, 40.8%, and 82%, respectively,p< 0.05) or family influence (44.4%, 38.8%, and 51.7%, respectively,p> 0.05) are the main reasons. Cultural and environmental factors, such as influences from family members’ preferences in the three countries or the ownership of housing/housing settings in Japan, are the main challenges in achieving POD congruence.Conclusions: Culturally inclusive strategies in clinical practice and policy implementation for identifying the preferred POD, enhancing communication among stakeholders, and facilitating transitional support may improve the quality of goal-concordant care.
背景/目的：患者死亡地点是衡量临终关怀质量的重要指标。本研究旨在探讨东亚地区晚期癌症患者死亡地点的一致性及其决策背后的原因。方法：我们在日本、韩国和台湾的安宁疗护病房开展了一项前瞻性多中心队列研究。数据由责任医师在常规临床实践中收集，并采用桑基图展示死亡地点不一致原因的变化情况。结果：研究共纳入三国37个安宁疗护病房的2638名参与者，其中绝大多数患者在安宁疗护病房离世（日本：95.7%，韩国：94%，台湾：82%，p<0.05）。安宁疗护病房住院患者的期望死亡地点与实际死亡地点一致率在70%至80%之间。临终关怀服务的可及性是患者选择并最终在安宁疗护病房离世的最常见原因（分别为78.6%、72.2%和52.1%，p<0.05）。然而，仍有13-22%入住安宁疗护病房的患者更希望在家中离世，这主要受传统文化（分别为20.2%、40.8%和82%，p<0.05）或家庭因素（分别为44.4%、38.8%和51.7%，p>0.05）的影响。文化与环境因素，如三国中家庭成员偏好的影响，或日本住房产权/居住环境等，是实现死亡地点一致性的主要挑战。结论：在临床实践和政策实施中采用文化包容性策略，包括识别患者期望的死亡地点、加强利益相关者间的沟通以及提供过渡期支持，可能有助于提升目标一致性照护的质量。
肿瘤(癌症)患者之家