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abstract
Background: Achieving home care and home death is increasingly used as an outcome measure of palliative care services.
Aim: 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 20th
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.
Implications: 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.
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