Dying at home or in an institution: perspectives of Dutch physicians and bereaved relatives

Abstract

Introduction Previous studies have shown that most people prefer to die at their own home. We investigated whether physicians or bereaved relatives in retrospect differently appreciate the dying of patients in an institution or at home. Materials and methods Of 128 patients with incurable cancer who were followed in the last phase of their lives, 103 passed away during follow-up. After death, physicians filled out a written questionnaire for 102 of these patients, and 63 bereaved relatives were personally interviewed. Results Of 103 patients, 49 died in an institution (mostly a hospital), and 54 died at home (or in two cases in a homelike situation). Patients who had been living with a partner relatively often died at home. Bereaved relatives knew of the patient's wish to die at home in 25 out of 63 cases; 20 of these patients actually died at home. Thirty-one patients had no known preference concerning their place of dying. Most symptoms and the care provided to address them were equally prevalent in patients dying in an institution and patients dying at home. Bereaved relatives were in general quite satisfied about the provision of medical and nursing care in both settings. ConclusionWe conclude that most patients' preferences concerning the place of dying can be met. In about half of all cases, patients do not seem to have a clear preference concerning their place of dying, which is apparently not a major concern for many people. We found no indication that dying in an institution or at home involves major differences in the process and quality of dying.

How Do Cancer Patients Receiving Palliative Care at Home Die? A Descriptive Study

“…22 In another study, there was no indication that dying in an institution or at home involves major differences and quality of dying. 23 Both studies, however, did not analyze the real circumstances of death, which was the main aim of this observational study.…”

Is home always the best and preferred place of death?

“…3 6 13-15 However, there is considerable variation between studies. A substantial number of people do not specify a preference, 16 and there is rarely an option for "it depends" or "does not matter." 17 The context and framing of the questions will shape the nature of responses, and studies vary in their design and quality.…”

The potential cost savings of greater use of home- and hospice- based end of life care in England

“…This of course can be accomplished in several care settings. For example, in a study of a cohort of 128 patients with incurable cancer, Van der Heide et al (2007) found no indication that dying in an institution or at home involve major differences in the process and quality of dying.…”