Dying in hospital or at home? a systematic review of the literature on the motivations for choosing the place of end of life for patients with chronic diseases

Abstract

In many countries, palliative care is provided in hospitals and hospices. Over time, palliative care has developed outside general health care and is provided in the patient's home. We examine the motivations for preferences for place of care at the end of life, and the reasons for changes in these preferences in so-called developed and developing countries. Pubmed, Google Scholar and Social Sciences Citation Index databases were searched as of January 2021. Qualitative and mixed studies on terminal care, preferences for end-of-life care settings and palliative care settings were considered. The inclusion criteria were studies published between 1980 and 2021 in English or French and dealing with preferences for place of care at the end of life and negotiations around the choice of end-of-life location. Place of residence and environment motivated the choice of home, while the socioeconomic position of patients and families partly motivated the choice of hospital. The most important reasons for choosing to leave the hospital for the home were structural dysfunction in the delivery of palliative care (developed and developing countries), cultural and belief imprint (developed and developing countries), and the quest for a good death (developing countries). End-of-life care at home was the most common preference. Return to hospital was the second preference, especially for advanced diseases such as genetic diseases, cancer, chronic hepatitis, malignant neoplasm. Study designs in this area need to be improved, especially in French West Africa.