title: The determinants of home and nursing home death: a systematic review and meta-analysis.
abstract: BACKGROUND
  Most Canadians die in hospital, and yet, many express a preference to die at home. Place of death is the result of the interaction among sociodemographic, illness- and healthcare-related factors. Although home death is sometimes considered a potential indicator of end-of-life/palliative care quality, some determinants of place of death are more modifiable than others. The objective of this systematic review was to evaluate the determinants of home and nursing home death in adult patients diagnosed with an advanced, life-limiting illness.
  
  
  METHODS
  A systematic literature search was performed for studies in English published from January 1, 2004 to September 24, 2013 that evaluated the determinants of home or nursing home death compared to hospital death in adult patients with an advanced, life-limiting condition. The adjusted odds ratios, relative risks, and 95% confidence intervals of each determinant were extracted from the studies. Meta-analyses were performed if appropriate. The quality of individual studies was assessed using the Newcastle-Ottawa scale and the body of evidence was assessed according to the GRADE Working Group criteria.
  
  
  RESULTS
  Of the 5,900 citations identified, 26 retrospective cohort studies were eligible. The risk of bias in the studies identified was considered low. Factors associated with an increased likelihood of home versus hospital death included multidisciplinary home palliative care, preference for home death, cancer as opposed to other diagnoses, early referral to palliative care, not living alone, having a caregiver, and the caregiver's coping skills.
  
  
  CONCLUSIONS
  Knowledge about the determinants of place of death can be used to inform care planning between healthcare providers, patients and family members regarding the feasibility of dying in the preferred location and may help explain the incongruence between preferred and actual place of death. Modifiable factors such as early referral to palliative care, presence of a multidisciplinary home palliative care team were identified, which may be amenable to interventions that improve the likelihood of a patient dying in the preferred location. Place of death may not be a very good indicator of the quality of end-of-life/palliative care since it is determined by multiple factors and is therefore dependent on individual circumstances.
authors.affiliation: Health Quality Ontario, 130 Bloor Street West, 10th floor, Toronto, M5S 1 N5, ON, Canada. costavania@hotmail.com.
authors.forename: Vania
authors.initials: V
authors.lastname: Costa
authors.affiliation: Ontario Institute for Cancer Research, 101 College Street, Toronto, M5G 1 L7, ON, Canada.
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.affiliation: de Souza Institute, University Health Network, 700 Bay Street, 19th floor, Toronto, M5G 1Z6, ON, Canada.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Esplen
authors.affiliation: Department of Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, M4N 3M5, ON, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.affiliation: Mount Sinai Hospital, Tammy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, L4-000, Toronto, M5T 3 L9, ON, Canada.
authors.forename: Russell
authors.initials: R
authors.lastname: Goldman
authors.affiliation: North York General Hospital, 4001 Leslie Street, Toronto, M2K 1E1, ON, Canada.
authors.forename: Daphna
authors.initials: D
authors.lastname: Grossman
authors.affiliation: MaRS Discovery District, 101 College Street, Toronto, M5G 1 L7, ON, Canada.
authors.forename: Leslie
authors.initials: L
authors.lastname: Levin
authors.affiliation: Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, K1Y 4E9, ON, Canada.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
authors.affiliation: Saint Elizabeth Health Care , 90 Allstate Parkway, Suite 300, Markham, L3R 6H3, ON, Canada.
authors.forename: Shirlee
authors.initials: S
authors.lastname: Sharkey
authors.affiliation: Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, K1Y 4E9, ON, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Tanuseputro
authors.affiliation: Departments of Medicine, and Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, L8S 4 K1, ON, Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: You
mesh_terms: D001293:Attitude to Death; D002170:Canada; D003643:Death; D006285:Health Planning / Q000706:statistics & numerical data; D006699:Home Care Services / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D009735:Nursing Homes / Q000592:standards / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013727:Terminal Care / Q000523:psychology*