Factors Associated with Congruence Between Preferred and Actual Place of Death

Abstract

Congruence between preferred and actual place of death may be an essential component in terminal care. Most patients prefer a home death, but many patients do not die in their preferred location. Specialized (physician, hospice and palliative) home care visits may increase home deaths, but factors associated with congruence have not been systematically reviewed. This study sought to review the extent of congruence reported in the literature, and examine factors that may influence congruence. In July 2009, a comprehensive literature search was performed using MEDLINE, Psych Info, CINAHL, and Web of Science. Reference lists, related articles, and the past five years of six palliative care journals were also searched. Overall congruence rates (percentage of met preferences for all locations of death) were calculated for each study using reported data to allow cross-study comparison. Eighteen articles described 30% to 91% congruence. Eight specialized home care studies reported 59% to 91% congruence. A physician-led home care program reported 91% congruence. Of the 10 studies without specialized home care for all patients, seven reported 56% to 71% congruence and most reported unique care programs. Of the remaining three studies without specialized home care for all patients, two reported 43% to 46% congruence among hospital inpatients, and one elicited patient preference "if everything were possible," with 30% congruence. Physician support, hospice enrollment, and family support improved congruence in multiple studies. Research in this important area must consider potential sources of bias, the method of eliciting patient preference, and the absence of a single ideal place of death.

Contending With Advanced Illness: Patient and Caregiver Perspectives

“…However, given the data that indicate relatively late hospice enrollment, unrelieved suffering at the end of life, 1 and the discrepancy between the numbers of Americans preferring to die at home and those who do, 26 it is clear that important care needs go unmet for many. Understanding the process of transition from cure-focused to comfort-focused care from the perspective of patient-caregiver dyads can inform provider actions to assist those for whom a transition to comfort care is the best choice.…”

Associations with the Japanese Population's Preferences for the Place of End-of-Life Care and Their Need for Receiving Health Care Services

“…19 These data demonstrated discrepancies between the rates of actual and preferred place of care and death, which were similar to those in developed countries as summarized by recent reviews. [20][21][22][23] Almost 80% of Japanese people actually spent time and died in a hospital, instead of their different preferred place of care in their end-of-life stage. Studies revealed that the preferences for end-of-life care and death change with one's personal life experience.…”

Is home always the best and preferred place of death?

“…3 Preferences for place of care are rarely clearly differentiated from place of death. 15 When they are, preference for care at home is greater than for death at home. 6 10 13 24 As with the evidence from public surveys, it seems that although patients may specify home as their preferred place, location may not be a high priority, 15 especially in comparison to freedom from distress and pain.…”

“…15 When they are, preference for care at home is greater than for death at home. 6 10 13 24 As with the evidence from public surveys, it seems that although patients may specify home as their preferred place, location may not be a high priority, 15 especially in comparison to freedom from distress and pain. 4 10 18 22 Qualitative evidence indicates that patient attitudes to place of death are complex, uncertain, shifting, and pragmatic.…”