• B Gomes, I J Higginson, N Calanzani, J Cohen, L Deliens, B A Daveson, D Bechinger-English, C Bausewein, P L Ferreira, F Toscani, A Meñaca, M Gysels, L Ceulemans, S T Simon, H R W Pasman, G Albers, S Hall, F E M Murtagh, D F Haugen, J Downing, J Koffman, F Pettenati, S Finetti, B Antunes, R Harding, and PRISMA.
• King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK. barbara.gomes@kcl.ac.uk
• Ann. Oncol. 2012 Aug 1;23(8):2006-15.

BackgroundCancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences for place of death cross-nationally.MethodsA telephone survey of a random sample of individuals aged ≥16 in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We determined where people would prefer to die if they had a serious illness such as advanced cancer, facilitating circumstances, personal values and experiences of illness, death and dying.ResultsOf 9344 participants, between 51% (95% CI: 48% to 54%) in Portugal and 84% (95% CI: 82% to 86%) in the Netherlands would prefer to die at home. Cross-national analysis found there to be an influence of circumstances and values but not of experiences of illness, death and dying. Four factors were associated with a preference for home death in more than one country: younger age up to 70+ (Germany, the Netherlands, Portugal, Spain), increased importance of dying in the preferred place (England, Germany, Portugal, Spain), prioritizing keeping a positive attitude (Germany, Spain) and wanting to involve family in decisions if incapable (Flanders, Portugal).ConclusionsAt least two-thirds of people prefer a home death in all but one country studied. The strong association with personal values suggests keeping home care at the heart of cancer EoLC.

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