Common Place Of Death Research Articles

Entwicklung der Sterbeorte von Pflegeheimbewohnern in einem städtischen Versorgungsbereich während der COVID-19-Pandemie – eine Auswertung von Daten des Sterberegisters

BackgroundThe nursing home is a common place of death; however, little is known about the place of death with respect to the people living there. Was there a difference in the frequencies of the places of death of nursing home residents in an urban district and in the individual facilities before and during the COVID-19 pandemic? MethodsFull survey of deaths by retrospective analysis of death registry data from the years 2018 to 2021. ResultsOver the four-year period 14,598 people died, with 3,288 (22.5%) being residents of 31 different nursing homes. Over the reference period before the pandemic (March 1, 2018 to December 31, 2019) 1,485 nursing home residents died: 620 (41.8%) in hospital, 863 (58.1%) in a nursing home. During the pandemic period (March 1, 2020 to December 31, 2021) 1,475 death were registered: 574 (38.9%) in hospital and 891 (60.4%) in a nursing home. The mean age over the reference period was 86.5 years (±8,6; median 88.4; 47.9 to 106.2), in the pandemic period it was 86.7 years (±8,5; median 87.9; 43.7 to 111.7). Before the pandemic 1,006 deaths (67.7%) occurred in females, during the pandemic it was 969 (65.7%). The relative risk (RR) as a measure for the increase in the probabilty for an “in-hospital” death during the pandemic period was 0.94. In different facilities, the number of deaths per bed during the reference and the pandemic period varied between 0.26 and 0.98, and the RR from 0.48 to 1.61. DiscussionFor all nursing home residents, the frequency of deaths was not increasing and no shift towards an “in-hospital” death was observed. Several nursing homes revealed substantial differences and opposing trends. The strength and the type of effects of facility-related circumstances remain unclear.

Place of death among foreign-born individuals: a national population-based register study.

Relatively little is known about where foreign-born individuals die in Sweden and how birth region might influence place of death. Thus, there is a need for population-based studies investigating place of death and associated factors among foreign-born individuals. The aim of this study was to identify variations in place of death among foreign-born individuals residing in Sweden and to compare place of death between the foreign- and domestic-born population. We also examine the association between place of death, underlying cause of death and sociodemographic characteristics among the foreign-born population. A population-based register study. All deceased individuals ⩾18 years of age in Sweden with a registered place of death between 2012 and 2019 (n = 682,697). Among these, 78,466 individuals were foreign-born. Univariable multinomial logistic regression modelling and multivariable multinomial logistic regression analyses were performed. Overall, hospital was the most common place of death among the foreign-born population. However, there were variations in place of death related to region of birth. Compared to domestic-born, a higher proportion of foreign-born individuals dies at home, the majority of whom were born on the African continent. Region of birth is one of the several factors associated with place of death among foreign-born individuals. Further research is needed to explore both preferences and barriers to place of death among foreign-born individuals.

Place of death and phenomenon of going home to die in Chinese adults: A prospective cohort study

SummaryBackgroundChina is embracing an ageing population without sustainable end-of-life care services. However, changes in place of death and trends of going home to die (GHTD) from the hospital remains unknown.MethodsA total of 42,956 participants from the China Kadoorie Biobank, a large Chinese cohort, who died between 2009 and 2017 was included into analysis. GHTD was defined as death at home within 7 days after discharge from the hospital. A modified Poisson regression was used to investigate temporal trends of the place of death and GHTD, and estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association of GHTD with health insurance (HI) schemes.FindingsFrom 2009 to 2017, home remained the most common place of death (71·5%), followed by the hospital (21·6%). The proportion of GHTD for Urban and Rural Residents’ Basic Medical Insurance (URRBMI) beneficiaries was around six times higher than that for Urban Employee Basic Medical Insurance (UEBMI) beneficiaries (66·0% vs 11·6%). Besides, a substantial increase in the proportion of GHTD throughout the study period was observed regardless of HI schemes (4·4% annually for URRBMI, and 5·4% for UEBMI). Compared with UEBMI beneficiaries, URRBMI beneficiaries were more likely to experience GHTD, with an adjusted PR (95% CI) of 1·19 (95% CI: 1·12, 1·27) (P<0·001).InterpretationIn China, most of deaths occurred at home, with a large proportion of decedents GHTD from the hospital, especially for URRBMI beneficiaries. Substantial variation in the phenomenon of GHTD across HI schemes indicates inequalities in end-of-life care utilization.FundingThe National Natural Science Foundation of China, the Kadoorie Charitable Foundation, the National Key R&D Program of China, the Chinese Ministry of Science and Technology.

Place of death in Europe: trends and associations in a 30-country panel (2005-2017)

Abstract Background End-of-life care attracts major policy interest. Place of death is an important metric of individual experience and health system performance. Most people prefer to die at home, but hospital is the most common place of death in high-income countries. Little is known about international trends in place of death over time. Methods We aimed to collate population-level data on place of death in Europe for the years 2005-2017, and to evaluate association with national characteristics and policy choices. We sought outcome data from the 32 European Economic Area countries. We identified national economic, societal, demographic and health system predictors from Eurostat, OECD and the WHO. We analysed these cross-national panel data using linear regression with panel-corrected standard errors. Results Our analytic dataset included 30 countries accounting for over 95% of Europe's population and economic activity. Average national proportion of deaths occurring in hospital in the study period ranged from 26% to 68%, with a median of 52%. Trends vary markedly by region and wealth, with low and decreasing hospital deaths in the North-West, and high and increasing prevalence in the South and East. Controlling for demographic and economic factors, strong palliative care provision and generous government finance of long-term care were associated with fewer hospital deaths. Conclusions We found modifiable policy choices associated with hospital mortality, as well as wider structural economic and societal factors. Policymakers can act to curb worrisome trends in-hospital mortality. Data on places of death outside hospital can improve future research, policy and practice. Key messages Cross-national longitudinal analysis. Trends of hospital deaths in Europe, association between hospital mortality rate, palliative care and other healthcare factors.

Proportion of deaths in hospital in European countries: trends and associations from panel data (2005-2017).

End-of-life care attracts major policy interest. Place of death is an important metric of individual experience and health system performance. Most people prefer to die at home, but hospital is the most common place of death in high-income countries. Little is known about international trends in place of death over time. We aimed to collate population-level data on place of death in Europe from 2005 to 2017, and to evaluate association with national characteristics and policy choices. We sought data on hospital as the place of death from the 32 European Economic Area countries. We identified national economic, societal, demographic and health system predictors from Eurostat, OECD and the WHO. We analyzed these cross-national panel data using linear regression with panel-corrected standard errors. Our analytic dataset included 30 countries accounting for over 95% of Europe's population. Average national proportion of deaths occurring in hospital in the study period ranged from 26% to 68%, with a median of 52%. Trends vary markedly by region and wealth, with low and decreasing rate in the North-West, and high and increasing prevalence in the South and East. Controlling for demographic and economic factors, strong palliative care provision and generous government finance of long-term care were associated with fewer hospital deaths. We found modifiable policy choices associated with hospital mortality, as well as wider structural economic and societal factors. Policymakers can act to reduce the proportion of dying in hospital.

Patterns and costs of hospital-based cancer care in the last year of life: A national data linkage study in Scotland.

e18732 Background: Approximately thirty thousand people in Scotland are diagnosed with cancer each year, of whom 10,000 live less than one year. Hospital is the most common place of death for people with cancer, despite most expressing a preference for community-based care. There is inadequate understanding of the nature and value of hospital-based care for people with advanced cancer. This study aimed to describe patterns of hospital-based healthcare use and associated costs for cancer decedents in their last year of life. Methods: A population-wide administrative data linkage study of hospital-based healthcare use for cancer decedents aged 60+ at death who died between 2012 and 2017 was conducted in Scotland. Linkage was established between the Scottish Morbidity Record, Scottish Cancer Registry and the National Records of Scotland. Hospital admissions, length of stay (LoS), number and nature of outpatient and day case appointments were extracted. Associated costs were estimated using generalised linear models, adjusted for age, gender, primary cause of death, socioeconomic deprivation status, rural-urban (RU) status and comorbidity. Results: The study population included 85,732 decedents with a cancer diagnosis, for whom 64,553 (75.3%) cancer was the underlying cause of death. Mean age at death was 84 years. The mean number of inpatient stays in the last year of life was 5.88 (SD 5.68), with a mean LoS of 7 days. Mean total 1-year inpatient, outpatient and day-case costs per patient were £10,261, £1,275 and £977 respectively. People who died of haematological cancers had the most hospital admissions (mean 11.8). Admission rates rose sharply in the last month of life and were most common in those who died of haematological and lung cancers. One year adjusted and unadjusted costs decreased with increasing age. Unadjusted costs for the youngest group (60-64) were £15,895, double the cost for those aged 90+. People dying of haematological cancers had the highest hospital-based costs (mean £24,772) followed by those with ovarian cancer (mean £17,556). The largest single contributor to hospital-based costs in the last year of life was unscheduled admissions. Conclusions: People in Scotland in their last year of life with cancer use substantial hospital-based care. Unscheduled admission rates are high, particularly in the last month of life when the value of acute intervention may be uncertain. Further research is needed to examine triggers for hospitalisation and to assess the value of hospital-based care to people living with advanced cancer.

Retrospective analysis of mortality within 30 days of systemic anticancer therapy and comparison with a previous audit at an Australian Regional Cancer Centre.

To retrospectively determine the rate of death occurring within 14 and 30 days of systemic anticancer therapy (SACT), compare this against a previous audit and benchmark results against other cancer centres. Secondly, to determine if the introduction of immune checkpoint inhibitors (ICI), not available at the time of the initial audit, impacted mortality rates. All adult solid tumour and haematology patients receiving SACT at an Australian Regional Cancer Centre (RCC) between January 2016 and July 2020 were included. Over a 55-month period, 1709 patients received SACT. Patients dying within 14 and 30 days of SACT were 3.3% and 7.0% respectively and is slightly higher than our previous study which was 1.89% and 5.6%. Mean time to death was 15.5 days. Males accounted for 63.9% of patients and the mean age was 66.8 years. 46.2% of the 119 patients dying in the 30 days post SACT started a new line of treatment during that time. Of 98 patients receiving ICI, 22.5% died within 30 days of commencement. Disease progression was the most common cause of death (79%). The most common place of death was the RCC (38.7%). The rate of death observed in our re-audit compares favourably with our previous audit and is still at the lower end of that seen in published studies in Australia and internationally. Cases of patients dying within 30 days of SACT should be regularly reviewed to maintain awareness of this benchmark of quality assurance and provide a feedback process for clinicians.

Who are dying and why? A case series study of maternal deaths in Nepal

ObjectivesTo identify delays and associated factors for maternal deaths in Nepal.DesignA cross-sectional case series study of maternal deaths. An integrated verbal and social autopsy tool was used to collect quantitative...

Changing Mortality and Place of Death in Response to Refugee Influx: A Population-Based Cross-Sectional Study in Jordan, 2005-2016.

Background: Jordan faces complex health care challenges due to refugee influx and an aging population. Palliative care planning and delivery require data to ensure services respond to changing population needs. Objectives: To determine the trend in mortality and place of death in Jordan. Design: Population-based study. Setting/Subjects: Death registry data of adult decedents (n = 143,215), 2005-2016. Measurements: Descriptive statistics examined change in demographic and place of death (categorized as hospital and nonhospital). Binomial logistic regression compared the association between hospital deaths and demographic characteristics in 2008-2010, 2011-2013, and 2014-2016, with 2005-2007. Results: The annual number of deaths increased from 6792 in 2005 to 17,018 in 2016 (151% increase). Hospital was the most common place of death (93.7% of all deaths) in Jordan, and percentage of hospital deaths increased for Jordanian (82.6%-98.8%) and non-Jordanian decedents (88.1%-98.7%). There was an increased likelihood of hospital death among Jordanian decedents who died from nonischemic heart disease (odd ratio [OR]: 1.11, 95% confidence interval [CI]: 1.09-1.13, p < 0.001), atherosclerosis (OR: 1.10, 95% CI: 1.08-1.13, p < 0.001), renal failure (OR: 1.05, 95% CI: 1.02-1.08, p < 0.001), hemorrhagic fevers (OR: 1.09, 95% CI: 1.06-1.13, p < 0.001), and injury (OR: 1.18, 95% CI: 1.06-1.33, p < 0.001) in the period 2014-2016, compared with 2005-2007. There were similar increases in the likelihood of hospital death among non-Jordanians in 2014-2016 for the following conditions: malignant neoplasms (except leukemia), nonischemic heart disease, atherosclerosis, injury, and HIV, compared with 2005-2007. Conclusions: Country-level palliative care development must respond to both internal (aging) and external (refugee influx) population trends. Universal Health Coverage requires palliative care to move beyond cancer and meet population-specific needs. Community-based services should be prioritized and expanded to care for the patients with nonischemic heart disease, atherosclerosis, renal failure, hemorrhagic fevers, and injury.

Caregiver support and place of death among older adults.

As home becomes the most common place of death in the United States, information about caregiver support and place of death is critical to improve patient and caregiver experiences at end of life. We seek to examine (1) the association between family care availability and place of death; and (2) caregiving intensity associated with place of death. 2017 National Health and Aging Trends Study and National Study of Caregiving; nationally representative cross-sectional study of deceased older adults and last-month-of-life (LML) caregivers. United States; all places of deaths. Three-hundred and seventy-five decedents and 267 LML caregivers. Place of death (home, hospital, and nursing or hospice facility), family care availability (spouse/partner, household size, number of daughters and sons), caregiving intensity (hours of help provided at LML and a binary indicator for high care-related emotional difficulty). 38.9% of older adults died at home, followed by hospital (33.1%), and nursing or hospice facility (28.0%). In an adjusted multinomial logistic regression, decedents with larger household size (odds ratio [OR]: 0.441; 95% confidence interval [CI]: 0.269-0.724) and more daughters (OR: 0.743 [95% CI: 0.575-0.958]) had lower odds of dying in nursing or hospice facility relative to dying at home. For older adults who died at home, caregivers provided 209.8 h of help at LML. In contrast, when death occurred in nursing or hospice facility, caregivers provided 91.6 fewer hours of help, adjusted for decedent and caregiver characteristics. Dying in hospital was associated with higher odds of caregiver emotional difficulty relative to home deaths (OR: 4.093 [95% CI: 1.623-10.323]). Household size and number of daughters are important determinants of place of death. Despite dying at home being associated with more hours of direct caregiving; caregiver emotional strain was experienced as higher for hospital deaths. Better support services for end-of-life caregivers might improve patient and caregiver experiences for home and hospital deaths.

Developing a model of bereavement care in an adult tertiary hospital.

Objectives Hospitals are the most common place of death in Australia. Bereavement care is recognised by national standards as being central to providing high-quality care at the end of life, and has significant health implications on morbidity, mortality and health service usage. Despite this, bereavement care is not routinely or systematically provided in most Australian hospitals. This study aimed to develop a comprehensive, evidence-based model of bereavement care specific to the needs of an acute Australian adult tertiary hospital. Methods This study used a multiple-methods design, which included a scoping literature review, a survey of current institutional bereavement practices, interviews with bereaved family members and staff focus groups and the development of a model of bereavement care for the acute hospital service through advisory group and expert consensus. Results Staff and bereaved family members strongly supported a systematic approach to bereavement, perceiving the need for greater support, training, coordination and follow-up. In all, 10 core elements were developed to support a structured model of bereavement care provision and follow-up for the acute hospital organisation. Conclusions This evidence-generated model of care promotes the provision of quality and systematic bereavement care in the acute hospital setting. What is known about the topic? Acute hospitals are the most common place to die in Australia, yet there is a lack of understanding of how bereavement care is or should be provided in these environments. The bereavement period is associated with increased use of health services and worse morbidity and mortality, and thus has significant implications for public health. The provision of bereavement care in acute hospitals is often sporadic, often involving untrained staff who may not provide evidence-based care. What does this paper add? This paper describes the development of a comprehensive, evidence-based model of bereavement care specific to the needs of an Australian acute hospital. What are the implications for practitioners? Developing a consistent approach to bereavement for the acute care sector has the potential to support staff, minimise conflict at the end of life, facilitate recognition of those suffering from difficult bereavement and proactively engage services for these people. It is hoped that such a model of care can find relevance across acute hospitals in Australia, to improve the quality and consistency of bereavement care.

CARBON MONOXIDE RELATED DEATHS IN ALQURAYYATE, SAUDI ARABIA FROM 2004 TO 2018

The current work aimed to study carbon monoxide (CO) related deaths in Alqurayyate during the period from 2004-2018. Among 461 autopsied cases, 52 cases [11.3%] show carboxy-hemoglobin (COHb) levels≥ 10%. Higher COHb levels were significantly more common among males, young and elderly and Saudi people [0.012, 0.009, and 0.3 respectively]. was the cause of death in 19 cases [4.1%] while CO poisoning was suggested as a contributing factor in another 33 [7.2%] deaths. The mode of deaths was mainly accidental [78.8%]. Houses were the most common place of death [63.5%] and most CO related deaths happened in the winter months [73.1%]. The most common suggested source for exposure to CO among carbon monoxide poisoning (COP) deaths were car exhaust [36.8%], followed by charcoal heaters [31.6%]. Regarding autopsy findings, the external appearance revealed cherry red hypostasis in only 26.9% of CO related cases. The most common findings were pulmonary edema, cerebral edema, and congested lungs [96.2,82.7, and 80.8 % respectively]. Therefore, COP remains a common cause of death, inspite of the safety precautions. More public awareness programs about COP are recommended. Also, COHb levels should be routinely estimated in the autopsied cases, especially with suggestive history and death scene.

Cost-effectiveness analysis of systematic fast-track transition from oncological treatment to specialised palliative care at home for patients and their caregivers: the DOMUS trial

BackgroundWhile hospitals remain the most common place of death in many western countries, specialised palliative care (SPC) at home is an alternative to improve the quality of life for patients with incurable cancer. We evaluated the cost-effectiveness of a systematic fast-track transition process from oncological treatment to SPC enriched with a psychological intervention at home for patients with incurable cancer and their caregivers.MethodsA full economic evaluation with a time horizon of six months was performed from a societal perspective within a randomised controlled trial, the DOMUS trial (Clinicaltrials.gov: NCT01885637). The primary outcome of the health economic analysis was a incremental cost-effectiveness ratio (ICER), which is obtained by comparing costs required per gain in Quality-Adjusted Life Years (QALY). The costs included primary and secondary healthcare costs, cost of intervention and informal care from caregivers. Public transfers were analysed in seperate analysis. QALYs were measured using EORTC QLQ-C30 for patients and SF-36 for caregivers. Bootstrap simulations were performed to obtain the ICER estimate.ResultsIn total, 321 patients (162 in intervention group, 159 in control group) and 235 caregivers (126 in intervention group, 109 in control group) completed the study. The intervention resulted in significantly higher QALYs for patients when compared to usual care (p-value = 0.026), while being more expensive as well. In the 6 months observation period, the average incremental cost of intervention compared to usual care was €2015 per patient (p value < 0.000). The mean incremental gain was 0.01678 QALY (p-value = 0.026). Thereby, the ICER was €118,292/QALY when adjusting for baseline costs and quality of life. For the caregivers, we found no significant differences in QALYs between the intervention and control group (p-value = 0.630). At a willingness to pay of €80,000 per QALY, the probability that the intervention is cost-effective lies at 15% in the base case scenario.ConclusionThis model of fast-track SPC enriched with a psychological intervention yields better QALYs than usual care with a large increase in costs.Trial registrationThe trial was prospectively registered 25.6.2013. Clinicaltrials.gov Identifier: NCT01885637.

Trends in Place of Death for Individuals With Deaths Attributed to Advanced Chronic or End-Stage Kidney Disease in the United States

ContextAn important aspect of end-of-life care, place of death is understudied in advanced chronic (CKD) and end-stage kidney disease (ESKD). ObjectiveWe sought to examine trends and factors associated with where advanced CKD/ESKD patients die. MethodsWe conducted a retrospective cross-sectional study using mortality data from 2003 to 2017 for deaths attributed primarily to advanced CKD/ESKD in the United States. ResultsBetween 2003 and 2017, 222,247 deaths were attributed to advanced CKD/ESKD. From 2003 to 2017, deaths occurring in hospitals declined from 56.0% (n = 5356) to 35.6% (n = 7764), whereas increases occurred in deaths at home (13.5% [n = 1292] to 24.3% [n = 5306]), nursing facilities (18.6% [n = 1776] to 19.3% [n = 4221]), and hospice facilities (0.3% [n = 29] to 13.4% [n = 2917]). Nonwhite race was associated with increased odds of hospital death (Black [OR = 1.59; 95% CI = 1.55, 1.62]; Native American [OR = 1.47; 95% CI = 1.32, 1.63]; Asian [OR = 1.43; 95% CI = 1.32, 1.55] and reduced odds of nursing facility (Black [OR = 0.622; 95% CI = 0.600, 0.645]; Native American [OR = 0.638; 95% CI = 0.572, 0.712]; Asian [OR = 0.574; 95% CI = 0.533, 0.619], or hospice facility death (Black [OR = 0.843; 95% CI = 0.773, 0.918]; Native American [OR = 0.380; 95% CI = 0.289, 0.500]; Asian [OR = 0.609; 95% CI = 0.502, 0.739]). Older age was associated with reduced odds of hospital death (≥85 [OR = 0.334; 95% CI = 0.312, 0.358]) and increased odds of home (≥85 [OR = 1.55; 95% CI = 1.43, 1.68]), nursing facility (≥85 [OR = 3.09; 95% CI = 2.76, 3.45]) or hospice facility death (≥85 [OR = 1.60; 95% CI = 1.49, 1.72]). ConclusionsHospitals remain the most common place of death from advanced CKD/ESKD; however, the proportion of home, nursing facility, and hospice facility deaths have increased.

Changes in Place of Death in the United States (CS202A)

•Summarize temporal trends in place of death for individuals in the US.•Understand demographic and disease factors associated with place of death. Place of death is an important aspect of the patient/caregiver experience and knowing where patients die is essential for delivery of high-quality end-of-life care. To assess trends and factors associated with location of death among decedents from natural causes in the United States (US). We analyzed mortality data for all deaths in the US from 2003 to 2017. We used multivariable logistic regression to evaluate associations between demographic characteristics and place of death for years 2013-2017. Between 2003 and 2017, there were nearly 35.2 million natural deaths. In 2003, 905,874 deaths occurred in hospitals (39.7%), decreasing to 764,424 (29.8%) in 2017, while nursing facility deaths reduced from 538,817 (23.6%) to 534,714 (20.8%). Home deaths increased from 543,874 (23.8%) in 2003 to 788,757 (30.7%) in 2017, while hospice facility deaths increased from 5,395 (0.2%) to 212,652 (8.3%) by 2017. Younger patients, females, and racial/ethnic minorities had reduced odds of home death compared to older patients, males, and whites. Cancer patients had the greatest odds of home and hospice facility deaths and the lowest odds of nursing facility death, relative to other conditions. Dementia patients had the greatest odds of nursing facility death, and respiratory disease patients had the greatest odds of hospital death, relative to other conditions. Stroke patients had the lowest odds of home death, and cardiovascular disease patients had the lowest odds of hospice facility death, relative to other conditions. Home has surpassed hospital as the most common place of death in the US. Disparities in place of death exist by demographics and underlying cause of death.

Impact of advance care planning on the place of death for cancer patients: A retrospective cohort study.

e24007 Background: Place of death is an important indicator of quality of end-of-life care (EOLC). Most patients do not want to die in hospital and hospital deaths are costly to healthcare organisations. Advance care planning (ACP) includes discussions about where patients want to die. Cancer patients often have a distinct illness trajectory with a clear terminal phase, enabling opportunities for EOLC planning. This work aims to explore the impact of ACP on the outcomes and place of death for cancer patients. Methods: A retrospective decedent cohort study of 10,727 cancer patients with a Coordinate My Care (CMC) record created 2011-2019. CMC is a digital platform that enables patients to record, revise and share their ACP and EOLC preferences with primary, secondary and urgent healthcare providers in London. Logistic regression analysis was applied to examine the relationship between in-hospital death and a range of individual characteristics and EOLC preferences. Results: Only 1% chose hospital as their preferred place of death. Overall, 71% died in their place of preference. Home (42%) was the most common place of death, while 20% died in hospital. The likelihood in-hospital death is positively associated with being older (OR = 1.12, p &lt; 0.1), hospital being the preferred place of care (OR = 2.56, p &lt; 0.001), hospital being the preferred place of death (OR = 2.85, p &lt; 0.001) and if the preferred place of death is not recorded (OR = 1.32, p &lt; 0.001). By contrast, patients who are severely frail (OR = 0.61, p &lt; 0.001), who chose not to be resuscitated (OR = 0.56, p &lt; 0.001) and who have a ceiling of treatment for symptomatic rather than intensive hospital based treatments (OR = 0.40, p &lt; 0.001) are less likely to die in hospital. Conclusions: Most cancer patients prefer out-of-hospital death. Discussing, recording and sharing individual’s EOL preferences leads to better quality EOLC. Patient characteristics influence in-hospital deaths, but EOLC preferences exert stronger impact. Enabling cancer patients to die outside of hospital has positive implications for patients and their families and supports cost-effective use of healthcare resources.

Place of death of people with conditions needing palliative care in the different regions of Spain

Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (O-H/H) and in a nursing home vs. at home (O-N/H), and odds ratio (OR-H/H and OR-N/H) by multinomial logistic regression models. During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted O-H/H higher than 1 and O-N/H lower than 1 were observed in all AC, except Catalonia. Oncological causes made O-H/H lower than 1 in almost 50% of AC, while O-N/H continue to be lower than 1. Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect).

TRENDS AND FACTORS ASSOCIATED WITH PLACE OF DEATH AMONG INDIVIDUALS WITH CARDIOVASCULAR DISEASE IN THE UNITED STATES

While most patients prefer to die at home, trends and factors associated with place of death for patients dying of cardiovascular disease (CVD) remain unknown. Using data from the National Center for Health Statistics from 2003-2017, we described trends and conducted multivariable logistic regression to evaluate associations between demographic characteristics and place of death among CVD patients in the United States. From 2003-2017, the rate of CVD deaths occurring at home increased from 21.3% to 30.9%, and rate of hospice facility deaths increased from practically none to 6.0%. Over the same period, the rate of hospital deaths decreased from 36.5% to 27.3%, and nursing facility deaths decreased from 25.1% to 20.6%. With the exception of conduction disorders, temporal trends in place of death were consistent across CVD diagnosis subgroups: ischemic heart disease, hypertensive heart disease, heart failure/cardiomyopathy, cerebrovascular disease, aortic stenosis, and all other CVDs. Differences between demographic groups persisted over the study period, with reduced odds of home death among Hispanic versus non-Hispanic (OR=.942; 95% CI .929-.955) decedents, Black versus White (OR=.837; CI .809-.866) decedents and greater odds of home death among decedents with some college education or more (OR=1.08; CI 1.06-1.09) versus decedents with a high-school education or less. In 2014, home surpassed hospital as the most common place of death for CVD patients. CVD patients often have acute and intense needs at the end of life that are challenging to manage in the home and the quality of care these patients receive should be further investigated.

The Impact of Integrated Home Palliative Care Services on Resource Use and Place of Death.

Background: Specialized home-based palliative care (HPC) services aim at reducing the number of visits to emergency departments (EDs) and hospitalizations at end of life. In addition, it offers patients the possibility to die at home. Objective: To investigate whether the last years' expansion of palliative care in Stockholm County, Sweden, reduced the health care resource use and/or increased the number of patients who died at home. Design: This is a population-based study of all registered 2780 patients referred to HPC in 2015 in the Stockholm region. The majority of the patients (2087) had cancer, but 693 patients had chronic medical illness, most often cardiovascular and pulmonary diseases. Results: HPC reduced visits to the ED and hospital admissions by 51% and 41%, respectively. The number of hospital admissions to the departments of oncology, medicine, and surgery was reduced, whereas admissions to palliative care units increased. For the 1773 patients alive after 90 days with HPC, the number of days spent in hospital reduced from 19,628 before HPC to 13,743 (30%) days with HPC. The most common place of death was at a specialized palliative care unit (48%), whereas 36% died at home. Conclusions: HPC reduced emergency health care resource use for the majority of patients, despite patients having progressing disease. To improve the quality of end-of-life care, we need to make early integration of palliative care available for a larger number of patients. In addition, we have to improve care pathways, especially for patients with gastrointestinal and lung cancer, who continued to be frequently admitted to hospital.

Commonalities and differences in legal euthanasia and physician-assisted suicide in three countries: a population-level comparison.

To describe and compare euthanasia and physician-assisted suicide (EAS) practice in Flanders, Belgium (BE), the Netherlands (NL) and Switzerland (CH). Mortality follow-back surveys among attending physicians of a random sample of death certificates. We studied 349 EAS deaths in BE (4.6% of all deaths), 851 in NL (4.6% of all deaths) and 65 in CH (1.4% of all deaths). People who died by EAS were mostly aged 65 or older (BE: 81%, NL: 77% and CH: 71%) and were mostly diagnosed with cancer (BE: 57% and NL: 66%). Home was the most common place of death in NL (79%), while in BE and CH, more variation was found regarding to place of death. The decision to perform EAS was more frequently discussed with a colleague physician in BE (93%) and NL (90%) than in CH (60%). EAS practice characteristics vary considerably in the studied countries with legal EAS. In addition to the legal context, cultural factors as well as the manner in which legislation is implemented play a role in how EAS legislation translates into practice.