title: Preferred and Actual Location of Death: What Factors Enable a Preferred Home Death?
abstract: BACKGROUND
  Fulfillment of patient preferences for location of dying is of continued end-of-life care interest. Of those voicing a preference, most prefer home. However the majority of deaths occur in an institutional setting.
  
  
  OBJECTIVE
  The study objective was to report on the congruence between the last preferred and actual location of death among adult Nova Scotians who died from chronic disease, and to identify individual, illness-related, and environmental factors associated with achieving a preferred home death.
  
  
  METHODS
  The study employed a population-based mortality follow-back telephone survey interview. Subjects were eligible death certificate identified informants (next-of-kin) of adults (aged 18+) (n = 1316) who died of advanced chronic diseases in the Canadian province of Nova Scotia between June 2009 and May 2011 who were knowledgeable about the decedent's care over the last month of life. Congruence was assessed as to whether or not the decedent died in their preferred death location. Among decedents preferring a home death, individual, illness-related, and environmental risk factor multivariable analyses were used to identify predictors of home death achievement.
  
  
  RESULTS
  Among all who voiced a preference (n = 606), 52% died in their preferred location (kappa: 0.29). Factors contributing independently to achievement of a preferred home death were emotional needs being met, nursing and family physician home visits, palliative care program involvement, and being at home for the majority of the last month.
  
  
  CONCLUSIONS
  This study identifies elements of primary and integrated care that address the gap between preferred and actual place of care.
authors.affiliation: 1 Department of Family Medicine, Dalhousie University , Halifax, Nova Scotia, Canada .
authors.forename: Fred
authors.initials: F
authors.lastname: Burge
authors.affiliation: 1 Department of Family Medicine, Dalhousie University , Halifax, Nova Scotia, Canada .
authors.forename: Beverley
authors.initials: B
authors.lastname: Lawson
authors.affiliation: 2 School of Health Administration, Dalhousie University , Halifax, Nova Scotia, Canada .
authors.forename: Grace
authors.initials: G
authors.lastname: Johnston
authors.affiliation: 3 Department of Community Health and Epidemiology, Dalhousie University , Halifax, Nova Scotia, Canada .
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Asada
authors.affiliation: 4 Department of Medicine, Division of Palliative Medicine, Queen Elizabeth II Health Sciences Centre , Halifax, Nova Scotia, Canada .
authors.forename: Paul F
authors.initials: PF
authors.lastname: McIntyre
authors.affiliation: 3 Department of Community Health and Epidemiology, Dalhousie University , Halifax, Nova Scotia, Canada .
authors.forename: Gordon
authors.initials: G
authors.lastname: Flowerdew
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D002908:Chronic Disease / Q000401:mortality / Q000523:psychology*; D003644:Death Certificates; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods / Q000592:standards*; D057240:Patient Preference; D011159:Population Surveillance; D013727:Terminal Care / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult