title: Dying at home--is it better: a narrative appraisal of the state of the science.
abstract: BACKGROUND
  Achieving home care and home death is increasingly used as an outcome measure of palliative care services.
  
  
  OBJECTIVE
  To appraise the state of the science on dying at home.
  
  
  METHODS
  Appraisal and narrative review developed from a plenary presentation at the European Association for Palliative Care (EAPC) 2012 meeting examining the research on variations and trends in place of death, factors associated with dying in the preferred place, presenting evidence on outcomes for those dying at home and suggesting future research questions.
  
  
  RESULTS
  Meeting patients' preferences and creating home-like environments has been a major concern for hospice and palliative care since its inception. During the 20(th) century, in many countries, hospital deaths increased and home deaths reduced. Despite the fact that this trend has been halted or reversed in some countries (notably the United States, Canada and, more recently, the United Kingdom) in the last 5-20 years, a home death is still a distant reality for the majority, even though evidence shows it is the most commonly preferred place to die. Epidemiological studies identified factors associated with home death, including affluence, patients' preferences, provision of home care and extended family support. Evidence about the benefits of home care is conflicting, but recent data suggest that holistic well-being may be greater at home.
  
  
  CONCLUSIONS
  We call for further analyses of variations in place of care and place of death and robust studies on how patients and families formulate and change preferences over time. Regular monitoring of outcomes, quality and costs of palliative home care is urged.
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Vera P
authors.initials: VP
authors.lastname: Sarmento
authors.forename: Natalia
authors.initials: N
authors.lastname: Calanzani
authors.forename: Hamid
authors.initials: H
authors.lastname: Benalia
authors.forename: Barbara
authors.initials: B
authors.lastname: Gomes
mesh_terms: D001293:Attitude to Death; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D057240:Patient Preference; D013727:Terminal Care / Q000379:methods*
keywords: Home care; end-of-life care; hospice; palliative care; patient preference; terminal care