Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy.
BACKGROUND
Haematological malignancies are a common, heterogeneous and complex group of diseases that are often associated with poor outcomes despite intensive treatment. Research surrounding end-of-life issues, and particularly place of death, is therefore of paramount importance, yet place of death has not been formally reviewed in these patients.


METHODS
A systematic literature review and meta-analysis was undertaken using PubMed to identify all studies published between 1966 and 2010. Studies examining place of death in adult haematology patients, using routinely compiled morbidity and mortality data and providing results specific to this disease were included. 21 studies were identified with descriptive and/or risk-estimate data; 17 were included in a meta-analysis.


RESULTS
Compared to other cancer deaths, haematology patients were more than twice as likely to die in hospital (Odds Ratio 2.25 [95% Confidence Intervals, 2.07-2.44]).


CONCLUSIONS
Home is generally considered the preferred place of death but haematology patients usually die in hospital. This has implications for patients who may not be dying where they wish, and also health commissioners who may be funding costly end-of-life care in inappropriate acute hospital settings. More research is needed about preferred place of care for haematology patients, reasons for hospital deaths, and how these can be avoided if home death is preferred.
Epidemiology and Genetics Unit, Department of Health Sciences, Seebohm Rowntree Building, University of York, YO10 5DD, UK. debra.howell@egu.york.ac.uk.
Debra A
DA
Howell
Eve
E
Roman
Helen
H
Cox
Alexandra G
AG
Smith
Russell
R
Patmore
Anne C
AC
Garry
Martin R
MR
Howard