Abstract
Aims: A majority of patients dying from chronic life-limiting diseases prefer to die at home, yet many still die in hospital. Comparing place of death cross-nationally can indicate margins for improvement and policy suggestions. We aimed to compare the place of death of people who could have benefitted from palliative care in nine European and five non-European countries, and examine to what extent country-variation in place of death is related to socio-demographic, clinical and healthcare factors.
Methods: Death certificate data for all 2008 deaths in Belgium, England, Wales, France, Italy, Mexico, Netherlands, New Zealand, Canada, Czech Republic, Hungary, South Korea, USA and Spain (Andalusia) with an underlying cause of death corresponding to the minimal palliative care subset (Rosenwax et al. 2005) linked with regional healthcare statistics (N=2,220,997). Descriptive statistics and multivariable logistic regression analyses were used.
Results: People who could have benefited from palliative care died at home in 13% (Canada) to 51% (Mexico) of cases, in hospital in 25% (Netherlands) to 85% (South Korea) of cases, and in nursing home in 1% (South Korea) to 35% (Netherlands) of cases. The large differences across countries in the proportion of people dying at home and elsewhere were only partly explained by differences in age, sex, marital status, cause of death, and the availability of hospital beds, long-term care beds and general practitioners.
Conclusion: Country differences in place of death in a palliative care eligible population are only partly explained by differences in healthcare provision and socio-demographic and clinical differences and are thus likely attributable to different palliative and end-of-life care policies, strategies and practices. Our findings facilitate a further identification of policies and practices that can enable people to die in their place of choice within particular cultural, political and economic contexts.
Methods: Death certificate data for all 2008 deaths in Belgium, England, Wales, France, Italy, Mexico, Netherlands, New Zealand, Canada, Czech Republic, Hungary, South Korea, USA and Spain (Andalusia) with an underlying cause of death corresponding to the minimal palliative care subset (Rosenwax et al. 2005) linked with regional healthcare statistics (N=2,220,997). Descriptive statistics and multivariable logistic regression analyses were used.
Results: People who could have benefited from palliative care died at home in 13% (Canada) to 51% (Mexico) of cases, in hospital in 25% (Netherlands) to 85% (South Korea) of cases, and in nursing home in 1% (South Korea) to 35% (Netherlands) of cases. The large differences across countries in the proportion of people dying at home and elsewhere were only partly explained by differences in age, sex, marital status, cause of death, and the availability of hospital beds, long-term care beds and general practitioners.
Conclusion: Country differences in place of death in a palliative care eligible population are only partly explained by differences in healthcare provision and socio-demographic and clinical differences and are thus likely attributable to different palliative and end-of-life care policies, strategies and practices. Our findings facilitate a further identification of policies and practices that can enable people to die in their place of choice within particular cultural, political and economic contexts.
| Original language | English |
|---|---|
| Number of pages | 1 |
| Journal | Palliative Medicine |
| Volume | 28 |
| Publication status | Published - 6 Jun 2014 |
| Event | 8th world research congress of the European Association for Palliative Care (EAPC) - Lleida, Spain Duration: 5 Jun 2014 → 7 Jun 2014 |
Keywords
- place of death
- palliative care
- end of life care
- death certificates