Factors influencing death at home in terminally ill patients with cancer: systematic review.
OBJECTIVE
To determine the relative influence of different factors on place of death in patients with cancer.


METHODS
Four electronic databases-Medline (1966-2004), PsycINFO (1972-2004), CINAHL (1982-2004), and ASSIA (1987-2004); previous contacts with key experts; hand search of six relevant journals.


METHODS
We generated a conceptual model, against which studies were analysed. Included studies had original data on risk factors for place of death among patients, > 80% of whom had cancer. Strength of evidence was assigned according to the quantity and quality of studies and consistency of findings. Odds ratios for home death were plotted for factors with high strength evidence.


RESULTS
58 studies were included, with over 1.5 million patients from 13 countries. There was high strength evidence for the effect of 17 factors on place of death, of which six were strongly associated with home death: patients' low functional status (odds ratios range 2.29-11.1), their preferences (2.19-8.38), home care (1.37-5.1) and its intensity (1.06-8.65), living with relatives (1.78-7.85), and extended family support (2.28-5.47). The risk factors covered all groups of the model: related to illness, the individual, and the environment (healthcare input and social support), the latter found to be the most important.


CONCLUSIONS
The ne of factors that influence where patients with cancer die is complicated. Future policies and clinical practice should focus on ways of empowering families and public education, as well as intensifying home care, risk assessment, and training practitioners in end of life care.
The Cicely Saunders Foundation/Department of Palliative Care, Policy, and Rehabilitation, King's College London, London SE5 9RJ. barbara.gomes_da_silva@kcl.ac.uk
Barbara
B
Gomes
Irene J
IJ
Higginson
D001293:Attitude to Death; D003643:Death; D006297:Health Services Accessibility; D006699:Home Care Services / Q000592:standards / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006792:House Calls; D006801:Humans; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D017060:Patient Satisfaction; D012111:Residence Characteristics; D012307:Risk Factors; D012944:Social Support; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000706:statistics & numerical data*; D013997:Time Factors