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Multiple factors that can be acted on influence whether terminally ill patients’ preferences for location of death will be met

Costa V, Earle CC, Esplen MJ, et al.  The determinants of home and nursing home death: A systematic review and meta-analysis  BMC Palliative Care. 2016;15(8).

Review question

Which factors play an important role in determining the location of death (i.e., homes or nursing homes) among adult patients diagnosed with an advanced, life-limiting disease?

Background

Many Canadians die in hospitals, and yet a large number of patients have a preference to die at home.

In particular, when considering the needs of terminally ill patients, certain places of death may be more appropriate for some patients than others. This decision is influenced by an interplay of socio-demographic, illness- and healthcare-related factors.

Evaluating the factors that determine whether terminally ill patients die at home or in a nursing home is a promising means to better inform discussions among healthcare providers, patients and their families regarding patient preferences and the feasibility of dying in a preferred location.

How the review was done

A detailed search of a number of electronic databases for studies published from January 2004 to September 2013 was conducted. Studies that focused on the determinants of death at home or in nursing homes compared to hospitals, were included in the review.

A total of 5,899 studies were identified in searches, and 26 were included in the review after assessments for eligibility.

This review was funded by Health Quality Ontario.

What the researchers found

The review found studies that show satisfaction with end-of-life care is improved when patients die in their preferred location, and information on determinants of place of death may be used by policymakers to attempt to create conditions that enable patients to die in their preferred location.

Some factors identified are related to the illness and may not be modifiable such as the type of disease, living arrangements and the presence of symptoms that result in frequent hospital admissions.

However, some factors can be acted upon in order to improve the likelihood that the patients’ preferences will be met. These include the presence of a multidisciplinary palliative care team in the home, and the availability of palliative care services in the nursing home, providing support to the patient and caregiver, and timely referral to palliative care services.

Conclusion

The review identified multiple factors that influence the location of a terminally ill patient’s location of death. Having an understanding of these factors better informs the discussions among healthcare providers, families and patients regarding the preferred location, and perhaps explains the incongruence between the preferred and actual place of death.