Final transitions to place of death: patients and families wishes.
This four-country study (Belgium, the Netherlands, Italy and Spain) examines prevalence and types of final transitions between care settings of cancer patients and the extent to which patient/family wishes are cited as a reason for the transition.



Data were collected from the EUROSENTI-MELC study over a 2-year period. General practitioners within existing Sentinel Networks registered weekly all deaths of patients within practices using a standardized questionnaire. This registration included place of care in the final 3 months and wishes for the final transition to place of death. All non-sudden deaths due to cancer (+18 years) were included in the analyses.



We included 2048 non-sudden cancer deaths; 63% of patients had at least one transition between care settings in the final 3 months of life. 'Hospital death from home' (25-55%) and 'home death from hospital' (16-30%) were the most frequent types of final transitions in all countries. Patients' or families' wishes were mentioned as a reason for a final transition in 5-27% (P < 0.001) and 10-22% (P = 0.002) across countries.



'Hospital deaths from home' is the most prevalent final transition in three of four countries studied, in a significant minority of cases because of patient/family wishes.
End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.|Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Lieve
L
Van den Block
End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
Winne
W
Ko
Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, ISPO, Florence, Italy.
Guido
G
Miccinesi
Public Health and Surveillance, Scientific Institute of Public Health , Brussels, Belgium.
Sarah
S
Moreels
NIVEL Primary Care Database, Sentinel Practices, Netherlands Institute for Health Services Research , Utrecht, the Netherlands.
Ge A
GA
Donker
EMGO Institute for Health and Care Research, Department of Public and Occupational Health, and Palliative Care Expertise Centre, VU University Medical Centre, Amsterdam, the Netherlands.
Bregje
B
Onwuteaka-Philipsen
Public Health Directorate General, Health Department, Valladolid, Spain.
Tomas V
TV
Alonso
End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.|Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
Luc
L
Deliens
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003643:Death; D005060:Europe / Q000453:epidemiology; D005190:Family / Q000523:psychology*; D005260:Female; D058005:General Practitioners; D006699:Home Care Services; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D010361:Patients; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods* / Q000523:psychology*; D055815:Young Adult
advanced cancer; care settings; general practitioners; place of death; transitions; wishes