Actual and preferred place of death of home-dwelling patients in four European countries: making sense of quality indicators

PLoS One. 2014 Apr 8;9(4):e93762. doi: 10.1371/journal.pone.0093762. eCollection 2014.


Background: Dying at home and dying at the preferred place of death are advocated to be desirable outcomes of palliative care. More insight is needed in their usefulness as quality indicators. Our objective is to describe whether "the percentage of patients dying at home" and "the percentage of patients who died in their place of preference" are feasible and informative quality indicators.

Methods and findings: A mortality follow-back study was conducted, based on data recorded by representative GP networks regarding home-dwelling patients who died non-suddenly in Belgium (n = 1036), The Netherlands (n = 512), Italy (n = 1639) or Spain (n = 565). "The percentage of patients dying at home" ranged between 35.3% (Belgium) and 50.6% (The Netherlands) in the four countries, while "the percentage of patients dying at their preferred place of death" ranged between 67.8% (Italy) and 86.0% (Spain). Both indicators were strongly associated with palliative care provision by the GP (odds ratios of 1.55-13.23 and 2.30-6.63, respectively). The quality indicator concerning the preferred place of death offers a broader view than the indicator concerning home deaths, as it takes into account all preferences met in all locations. However, GPs did not know the preferences for place of death in 39.6% (The Netherlands) to 70.3% (Italy), whereas the actual place of death was known in almost all cases.

Conclusion: GPs know their patients' actual place of death, making the percentage of home deaths a feasible indicator for collection by GPs. However, patients' preferred place of death was often unknown to the GP. We therefore recommend using information from relatives as long as information from GPs on the preferred place of death is lacking. Timely communication about the place where patients want to be cared for at the end of life remains a challenge for GPs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Death*
  • Belgium
  • Decision Making
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Netherlands
  • Palliative Care* / statistics & numerical data
  • Quality Indicators, Health Care / statistics & numerical data
  • Spain
  • Terminal Care* / statistics & numerical data
  • Young Adult

Grant support

Funding for the study came from the Institute for the Promotion of Innovation by Science and Technology in Flanders as a Strategic Basic Research project (SBO) (contract SBO IWT 050158) (2006–2010), as part of the “Monitoring Quality of End-of-Life Care (MELC) Study”, a collaboration between the Vrije Universiteit Brussel, Ghent University, Antwerp University, the Scientific Institute for Public Health, Belgium, and VU University Medical Centre Amsterdam, the Netherlands. Funding also came from the Italian Ministry of Health through the “Evaluation, testing and implementation of supportive care, care interventions, integrated programs and improving the quality of care for cancer patients” program (“Integrated Oncology Project n°6, years 2008–2011”), led by Massimo Costantini (IRCCS AOU San Martino-IST, Genoa), from the annual budgets of the Autonomous Community of Castilla y León and Comunitat Valenciana and from EUROIMPACT: European Intersectorial and Multidisciplinary Palliative Care Research Training, funded by the European Union Seventh Framework Programme (FP7/2007–2013, under grant agreement n° [264697]). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.