Where the dying live: a systematic review of determinants of place of end-of-life cancer care.
OBJECTIVE
To describe the determinants of place of end-of-life (EOL) care for patients with cancer.


METHODS
A systematic literature review of primary research studies (1997-2007) was conducted. Studies that investigated place of EOL care or identified place of EOL care in relation to outcomes were examined, their critical quality was appraised, and references were mapped.


RESULTS
Of the 735 articles identified, 39 (representing 33 studies) met inclusion criteria. Two main research designs emerged: large-scale epidemiologic reports and smaller descriptive studies. Findings suggest that factors related to the disease, the individual, and the care and social environment influence place of EOL care for patients with cancer. Social support, healthcare inputs (from services and programs and healthcare provider contact), and patient preferences were the most important factors.


CONCLUSIONS
Most patients with terminal cancer prefer home palliation; however, most die in an institution. The reasons are complex, with various determinants influencing decisions regarding place of EOL care.


CONCLUSIONS
Findings may highlight evidence-based interventions to assist patients and families facing decisions regarding place of EOL care. A clearer understanding of factors that influence place of EOL care for patients with cancer could enhance healthcare policy and guide needs-based modifications of the healthcare system.
Murray
Mary Ann
MA
School of Nursing, University of Ottawa, Ottawa, Canada. maryannmurray@rogers.com
Fiset
Valerie
V
Young
Sandra
S
Kryworuchko
Jennifer
J
D015706:Bibliometrics; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D017028:Caregivers / Q000523:psychology; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006738:Hospices / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy; D009735:Nursing Homes / Q000706:statistics & numerical data; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000523:psychology / Q000706:statistics & numerical data*