• I R McWhinney, M J Bass, and V Orr.
• Department of Family Medicine, University of Western Ontario, London.
• CMAJ. 1995 Feb 1;152(3):361-7.

ObjectiveTo identify factors associated with the location of death (home or hospital) of patients referred to a palliative care home support team.DesignRetrospective case-control chart review.SettingPalliative care inpatient unit with a home support team in a large chronic care hospital.SubjectsAll 75 patients receiving services from the home support team who died at home between June 1988 and January 1990 and 75 randomly selected patients receiving the same services who died in hospital.Outcome MeasuresPlace of death (home or hospital).ResultsOf the 267 patients referred to the palliative care home support team during the study period 75 (28.1%) died at home. Factors significantly associated with dying at home were the patient's preference for dying at home recorded at the time of the initial assessment (p < 0.001), a family member other than the spouse involved in the patient's care (p = 0.021) and the use of private shift nursing (p < 0.001). The patients who died in hospital were more likely than the other patients to have had no home visits from the palliative care team after the initial assessment (p = 0.04). The patient's preference for dying at home was not met if the caregiver could not cope or if symptoms were uncontrolled. The patient's preference for dying in hospital was not met if his or her condition deteriorated rapidly or if the patient died suddenly.ConclusionsPatients' preference as to place of death, level of caregiver support and entitlement to private shift nursing were significantly associated with patients' dying at home. The determination of these factors should be part of every palliative care assessment. Patients and their families should be informed about available home support services.

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