• J Townsend, A O Frank, D Fermont, S Dyer, O Karran, A Walgrove, and M Piper.
• MRC Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow.
• BMJ. 1990 Sep 1;301(6749):415-7.

ObjectiveTo assess the preference of terminally ill patients with cancer for their place of final care.DesignProspective study of randomly selected patients with cancer from hospital and the community who were expected to die within a year. Patients expected to live less than two months were interviewed at two week intervals; otherwise patients were interviewed monthly. Their main carer was interviewed three months after the patient's death.SettingDistrict general hospital, hospices, and patients' homes.Main Outcome MeasureStated preferred place of final care; actual place of death; reason for final hospital admission for those in hospital; community care provision required for home care.ResultsOf 98 patients approached, 84 (86%) agreed to be interviewed, of whom 70 (83%) died during the study and 59 (84%) stated a preferred place of final care: 34 (58%) wished to die at home given existing circumstances, 12 (20%) in hospital, 12 (20%) in a hospice, and one (2%) elsewhere. Their own home was the preferred place of care for 17 (94%) of the patients who died there, whereas of the 32 patients who died in hospital 22 (69%) had stated a preference to die elsewhere. Had circumstances been more favourable 67% (41) of patients would have preferred to die at home, 16% (10) in hospital, and 15% (9) in hospice.ConclusionWith a limited increase in community care 50% more patients with cancer could be supported to die at home, as they and their carers would prefer.

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