Review Article
Factors Associated with Congruence Between Preferred and Actual Place of Death

https://doi.org/10.1016/j.jpainsymman.2009.07.007Get rights and content
Under an Elsevier user license
open archive

Abstract

Congruence between preferred and actual place of death may be an essential component in terminal care. Most patients prefer a home death, but many patients do not die in their preferred location. Specialized (physician, hospice, and palliative) home care visits may increase home deaths, but factors associated with congruence have not been systematically reviewed. This study sought to review the extent of congruence reported in the literature and examine factors that may influence congruence. In July 2009, a comprehensive literature search was performed using MEDLINE, PsychInfo, CINAHL, and Web of Science. Reference lists, related articles, and the past five years of six palliative care journals were also searched. Overall congruence rates (percentage of met preferences for all locations of death) were calculated for each study using reported data to allow cross-study comparison. Eighteen articles described 30%–91% congruence. Eight specialized home care studies reported 59%–91% congruence. A physician-led home care program reported 91% congruence. Of the 10 studies without specialized home care for all patients, seven reported 56%–71% congruence and most reported unique care programs. Of the remaining three studies without specialized home care for all patients, two reported 43%–46% congruence among hospital inpatients, and one elicited patient preference “if everything were possible,” with 30% congruence. Physician support, hospice enrollment, and family support improved congruence in multiple studies. Research in this important area must consider potential sources of bias, the method of eliciting patient preference, and the absence of a single ideal place of death.

Key Words

Place of death
decision making
terminal care
palliative care
systematic review

Cited by (0)

This research was supported by The John A. Hartford Foundation Center of Excellence in Geriatrics, University of Hawaii; and Research Centers in Minority Institutions award 1 R25 RR019321 from the National Center for Research Resources, National Institutes of Health.