Dying at home or in an institution

Cohen, Joachim; Bilsen, Johan; Hooft, P.; Deboosere, Patrick; Wal, Gerrit van der; Deliens, Luc

doi:10.1016/j.healthpol.2005.11.003

Cited by 120 publications

(40 citation statements)

References 39 publications

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“…This highlights a major discrepancy between actual and preferred place of death as the majority of people in these countries expressed a preference to die at home (78% in CZ, [17]). This result is similar to other European countries [6,18] and confirms a common trend with more than half of the populations dying in a hospital setting (58.4% in CZ, 54.8% in SK).…”

Section: Discussionsupporting

confidence: 89%

“…The model was checked for multicollinearity and tested by Wald statistic and χ 2 Pearson test. In order to obtain a consistent sample suitable for regression modelling only people older than 50 years of age were included (N = 68799), because age is strongly related with cause of death [6]. All analyses were executed in IBM SPSS Statistics version 20.…”

Section: Methodsmentioning

confidence: 99%

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Place of death in the Czech Republic and Slovakia: a population based comparative study using death certificates data

2014

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BackgroundPlace of death represents an important indicator for end-of-life care policy making and is related to the quality of life of patients and their families. The aim of the paper is to analyse the place of death in the Czech Republic and Slovakia in 2011. Research questions were focused on factors influencing the place of death and specifically the likelihood of dying at home.MethodsWhole population data from death certificates for all deaths in the Czech Republic and Slovakia in 2011 were used for bivariate and multivariate analyses. Separate analysis using binary logistic regression was conducted for subpopulation of patients who died from chronic conditions.ResultsThe majority of population in both countries died in hospitals (58.4% the Czech Republic, 54.8% Slovakia), less than one-third died at home. In case of chronic conditions, death at home was significantly associated with underlying cause of death (cancer and heart failure), being male, age (older than 85, Slovakia only) and higher education (the Czech Republic only). Cancer and heart failure patients had higher chances to die at home than other chronic conditions.ConclusionsCzech and Slovak patients with chronic conditions are more likely to die in hospitals than in some other European Union member countries. This finding should be addressed by policy makers in promoting home hospice care services and education in palliative care for staff in nursing homes and other end-of-life settings.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Place of death in the Czech Republic and Slovakia: a population based comparative study using death certificates data

2014

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“…Studies provided insight into different settings where people die in Belgium [65], [66], [67], [68], [69], the determinants of place of death [66], [69], [70], [71], [72], [73], [74], [75], and how place of death compared internationally [70], [74], [76]. One study focused on transitions between settings [77].…”

Section: Resultsmentioning

confidence: 99%

Culture and End of Life Care: A Scoping Exercise in Seven European Countries

et al. 2012

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Aim Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. Methods We scoped the literature for Germany, Norway, Belgium, the Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. Results A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. Conclusion This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL care in the future.

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“…This often results in hospitalisation; it may also lead to rapid deterioration, and sometimes sudden death. [28][29][30][31] In this case, the transition from curative or life-prolonging care to a palliative approach may occur rapidly, leaving little time for advance care planning and discussion about preferred place of death. 32 Indeed, such situations may explain to some extent the relatively high proportion of people, particularly with AML and DLBCL, who died in intensive care settings, with escalation of treatment and a focus on prolonging life.…”

Section: Discussionmentioning

confidence: 99%

Preferred and actual place of death in haematological malignancy

Howell

Wang

Roman

et al. 2015

BMJ Support Palliat Care

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ObjectivesHome is considered the preferred place of death for many, but patients with haematological malignancies (leukaemias, lymphomas and myeloma) die in hospital more often than those with other cancers and the reasons for this are not wholly understood. We examined preferred and actual place of death among people with these diseases.MethodsThe study is embedded within an established population-based cohort of patients with haematological malignancies. All patients diagnosed at two of the largest hospitals in the study area between May 2005 and April 2008 with acute myeloid leukaemia, diffuse large B-cell lymphoma or myeloma, who died before May 2010 were included. Data were obtained from medical records and routine linkage to national death records.Results323 deceased patients were included. A total of 142 (44%) had discussed their preferred place of death; 45.8% wanted to die at home, 28.2% in hospital, 16.9% in a hospice, 5.6% in a nursing home and 3.5% were undecided; 63.4% of these died in their preferred place. Compared to patients with evidence of a discussion, those without were twice as likely to have died within a month of diagnosis (14.8% vs 29.8%). Overall, 240 patients died in hospital; those without a discussion were significantly more likely to die in hospital than those who had (p≤0.0001). Of those dying in hospital, 90% and 75.8% received haematology clinical input in the 30 and 7 days before death, respectively, and 40.8% died in haematology areas.ConclusionsMany patients discussed their preferred place of death, but a substantial proportion did not and hospital deaths were common in this latter group. There is scope to improve practice, particularly among those dying soon after diagnosis. We found evidence that some people opted to die in hospital; the extent to which this compares with other cancers is of interest.

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Dying at home or in an institution

Cited by 120 publications

References 39 publications

Place of death in the Czech Republic and Slovakia: a population based comparative study using death certificates data

Place of death in the Czech Republic and Slovakia: a population based comparative study using death certificates data

Culture and End of Life Care: A Scoping Exercise in Seven European Countries

Preferred and actual place of death in haematological malignancy

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