Is the Preferred Place of Death Met in Patients on Dialysis? A Systematic Review
Bibliographic record
Abstract
Background: Dialysis patients’ palliative care needs are frequently unmet. An important aspect of palliative care is to timely determine the preferred place of death. In this study, we questioned what the preferred place of death is in dialysis patients, and whether this is met at time of death. Methods: A systematic review was performed searching PubMed for studies on palliative care and preferred place of death in adult dialysis patients. Articles were screened by two observers on title, abstract and full text. Risk-of-bias was assessed with a tool for prevalence studies (Hoy et al.). Results: We included nine studies that reported a preferred place of death. The majority of patients (67-75%) preferred to die out-of-hospital. Janssen et al. reported the preferred place of death in 206 Dutch patients with end-stage organ failure as being at-home in 51%, in a hospital in 30%, in a nursing home or hospice in 10%, and unknown in 9%. Davison et al. observed similar rates of preferred death out-of-hospital in 238 Canadian predialysis patients, 295 dialysis patients and 51 kidney transplant recipients. Other studies did not specify the preferred out-of-hospital place of death. Four studies reported the actual place of death and observed an out-of-hospital death in between 42 and 80% of cases. Out-of-hospital death was reported more frequently in patients who were receiving palliative care, had advance care planning or opted for dialysis withdrawal. Most out-of-hospital deaths occurred at home. Janssen et al. observed that 39% of patients died at their preferred place of death. Conclusion: A large majority of dialysis patients prefer to die out-of-hospital, yet their preference is often not met at time of death. Advance care planning, palliative care and dialysis withdrawal emerged as factors that promote an out-of-hospital death. Comprehensive documentation of wants, values and needs for palliative care is warranted to enhance alignment with dialysis patients' preferences.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.082 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.008 |
| Bibliometrics | 0.011 | 0.012 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".