The determinants of place of death: an evidence-based analysis

Costa V
Record ID 32015000090
Authors' recommendations: The results obtained were consistent with previously published systematic reviews. Based on low quality evidence several factors were identified as determinants of place of death. Determinants that increased the likelihood of a death at home included: - interprofessional home end-of-life/palliative care - an earlier referral to end-of-life/palliative care services (a month or more before death) - type of underlying disease (for example, patients with cancer were more likely to die at home) - worse functional status - fewer hospitalizations during the last year of life - living arrangements such as living with someone - presence of an informal caregiver - informal caregiver coping - patient or family preference for a home death Determinants that affected a patient's likelihood of dying in a nursing home included the type of disease, a worse functional status, the availability of palliative/end-of-life services in the nursing home, having completed an advance directive, a longer duration of stay in the nursing home, nursing home bed availability, and whether the patient preferred to die there. The type of disease was also a factor in a patient's likelihood of dying in an inpatient palliative care unit or an inpatient hospice. The availability of palliative care was a factor for each of the 4 places of death that were considered in this analysis. If palliative care could be provided in any of these places—at home, in a nursing home, in an inpatient palliative care unit, or in an inpatient hospice—this increased a patient's likelihood of dying there instead of in hospital. On the other hand, the availability of end-of-life/palliative care in the hospital increased the likelihood of hospital compared to home death. An earlier referral to palliative care (a month or more before death) also increased the likelihood of dying in an inpatient hospice instead of in hospital. The availability of resources to support the patient's physical and psychological needs in the place of residence during the end-of-life period also affects where a person may die.
Project Status: Completed
Year Published: 2014
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Evidence-Based Medicine
  • Death
  • Palliative Care
  • Critical Pathways
  • Critical Care Nursing
  • Canada
  • Terminal Care
  • Home Care Services
  • Caregivers
  • Morbidity
  • Hospice Care
  • Nursing Homes
  • Hospitalization
  • Critical Illness
  • Patient Care Planning
  • Patient-Centered Care
Organisation Name: Health Quality Ontario
Contact Address: Evidence Development and Standards, Health Quality Ontario, 130 Bloor Street West, 10th floor, Toronto, Ontario Canada M5S 1N5
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Copyright: Health Quality Ontario
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