Objectives Approximately 70% of Americans would prefer to die at home and avoid hospitalization or intensive care during the terminal phase of illness. Given the wish to die at home, it should follow the majority of Americans achieves their wish. However, recent data indicate ~60% of people dies away from home or hospice care. This article sets out to understand what makes it so difficult to attain what we aspire for in death and provide a starting point for change.
Method The authors reviewed and analysed literature on elements which drive patients to continue treatment even though prospects are grim.
Results Six elements which combine into a system driving non-peaceful death were identified (western culture, healthcare system, pharmaceutical industry, professionals, family and loves ones, patients themselves) and complemented with three additional factors entrenched in us as humans which make the system particularly difficult to overcome ((rational) decision making, option framing, inability to change).
Conclusion Dying in peace is easier said than done because the cards are stacked against us and we seem to remain unaware of the breadth and depth at which continuing treatment is ingrained in our system.
- end of life care
- quality of life
- terminal care
Data availability statement
There are no data in this work (expect for data in articles referenced).
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Contributors BG: Manager in the Healthcare practice of Strategy& and involved in the strategic transformation towards appropriate care within a variety of hospitals. In this role, she also focuses on the last stages of life. BG: spent the summer of 2018 at Harvard University to study ‘Dying Well’. She performed literature analysis, co-authored the first draft and edited the feedback. JAMK: member of the Dutch Council of Health and Society involved in the national policy-making on the health and social domain. As chairman of the National Quality Council, he was responsible for the National Quality Standard Nursing Home Care and became more and more interested in last stage of life. He co-authored the first draft, gave feedback and supervised this project. Both authors reviewed successive drafts of the paper.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.