title: Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study.
abstract: BACKGROUND
  Studies show that most patients with advanced cancer prefer to die at home. However, not all have equal chances and the evidence is unclear on whether dying at home is better. This study aims to determine the association between place of death, health services used, and pain, feeling at peace, and grief intensity.
  
  
  METHODS
  Mortality follow-back study of 352 cancer patients who died in hospital (n = 177) or at home (n = 175) in London, UK. Bereaved relatives identified from death registrations completed a questionnaire including validated measures of patient's pain and peace in the last week of life and their own grief intensity. We determined factors influencing death at home, and associations between place of death and pain, peace, and grief.
  
  
  RESULTS
  Where people died was, for most (80%), the place where they lived during their last week of life. Four factors explained >91% of home deaths: patient's preference, relative's preference, home palliative care, or district/community nursing. The propensity of death at home also increased when the relative was aware of incurability and the patient discussed his/her preferences with family. Dying in hospital was associated with more hospital days, fewer general practitioner (GP) home visits, and fewer days taken off work by relatives. Adjusting for confounders, patients who died at home experienced similar pain levels but more peace in their last week of life (ordered log odds ratio 0.69, P = 0.007). Grief was less intense for their relatives than for those of patients who died in hospital (β, -0.15 around time of death and -0.14 at questionnaire completion, P = 0.02).
  
  
  CONCLUSIONS
  The study suggests that dying at home is better than hospital for peace and grief, but requires a discussion of preferences, GP home visits, and relatives to be given time off work.
  
  
  BACKGROUND
  National Institute of Health Research (NIHR) Clinical Research Network Portfolio. UKCRN7041.
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, SE5 9PJ, London, UK. barbara.gomes@kcl.ac.uk.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gomes
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, SE5 9PJ, London, UK. natalia.calanzani@ed.ac.uk.|University of Edinburgh, Medical School, Centre for Population Health Sciences, Teviot Place EH8 9AG, Edinburgh, UK. natalia.calanzani@ed.ac.uk.
authors.forename: Natalia
authors.initials: N
authors.lastname: Calanzani
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, SE5 9PJ, London, UK. jonathan.koffman@kcl.ac.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Koffman
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, SE5 9PJ, London, UK. irene.higginson@kcl.ac.uk.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D016022:Case-Control Studies; D003643:Death; D005260:Female; D006699:Home Care Services; D006761:Hospitals; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care; D057240:Patient Preference; D011795:Surveys and Questionnaires; D013727:Terminal Care