title: Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain.
abstract: BACKGROUND
  Cancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences for place of death cross-nationally.
  
  
  METHODS
  A telephone survey of a random sample of individuals aged ≥16 in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We determined where people would prefer to die if they had a serious illness such as advanced cancer, facilitating circumstances, personal values and experiences of illness, death and dying.
  
  
  RESULTS
  Of 9344 participants, between 51% (95% CI: 48% to 54%) in Portugal and 84% (95% CI: 82% to 86%) in the Netherlands would prefer to die at home. Cross-national analysis found there to be an influence of circumstances and values but not of experiences of illness, death and dying. Four factors were associated with a preference for home death in more than one country: younger age up to 70+ (Germany, the Netherlands, Portugal, Spain), increased importance of dying in the preferred place (England, Germany, Portugal, Spain), prioritizing keeping a positive attitude (Germany, Spain) and wanting to involve family in decisions if incapable (Flanders, Portugal).
  
  
  CONCLUSIONS
  At least two-thirds of people prefer a home death in all but one country studied. The strong association with personal values suggests keeping home care at the heart of cancer EoLC.
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK. Electronic address: barbara.gomes@kcl.ac.uk.
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authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
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authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
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authors.affiliation: End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.
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authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Palliative Care Center of Expertise, VU University Medical Center, Amsterdam, the Netherlands; End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.
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authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
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authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
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authors.lastname: Bechinger-English
authors.affiliation: Deutsche Gesellschaft für Palliativmedizin, Berlin, Germany; King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
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authors.affiliation: Centre for Health Studies and Research, University of Coimbra (CEISUC), Coimbra, Portugal.
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authors.affiliation: Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni ONLUS, Cremona, Italy.
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authors.affiliation: Barcelona Centre for International Health Research (CRESIB-Hospital Clínic), Universitat de Barcelona, Barcelona, Spain.
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authors.affiliation: Barcelona Centre for International Health Research (CRESIB-Hospital Clínic), Universitat de Barcelona, Barcelona, Spain.
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authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
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authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
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authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
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authors.affiliation: Centre for Health Studies and Research, University of Coimbra (CEISUC), Coimbra, Portugal; King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
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mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001293:Attitude to Death; D003431:Cross-Cultural Comparison; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D057240:Patient Preference; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*; D055815:Young Adult