Dying at home - Is it better: A narrative appraisal of the state of the science

I.J. Higginson, V.P. Sarmento, N. Calanzani, H. Benalia, B. Gomes

Research output: Contribution to journalArticlepeer-review

117 Citations (Scopus)

Abstract

Background: Achieving home care and home death is increasingly used as an outcome measure of palliative careservices.

Aim: To appraise the state of the science on dying at home.

Methods: Appraisal and narrative review developed from a plenary presentation at the European Associationfor Palliative Care (EAPC) 2012 meeting examining the research on variations and trends in place ofdeath, factors associated with dying in the preferred place, presenting evidence on outcomes forthose dying at home and suggesting future research questions.

Results: Meeting patients’ preferences and creating home-like environments has been a major concern forhospice and palliative care since its inception. During the 20th century, in manycountries, hospital deaths increased and home deaths reduced. Despite the fact that this trend hasbeen halted or reversed in some countries (notably the United States, Canada and, more recently, theUnited Kingdom) in the last 5–20 years, a home death is still a distant reality for the majority,even though evidence shows it is the most commonly preferred place to die. Epidemiological studiesidentified factors associated with home death, including affluence, patients’ preferences, provisionof home care and extended family support. Evidence about the benefits of home care is conflicting,but recent data suggest that holistic well-being may be greater at home.

Implications: We call for further analyses of variations in place of care and place of death and robust studieson how patients and families formulate and change preferences over time. Regular monitoring ofoutcomes, quality and costs of palliative home care is urged.
Original languageEnglish
JournalPalliative Medicine
Volume27
Issue number10
DOIs
Publication statusPublished - 2013

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