Factors associated with preference for dying at home among terminally ill patients with cancer

An important element in end-of-life care advocacy is to meet patients' end-of-life preferences. Most Scandinavian patients die in hospitals even though the majority prefers to die at home. Earlier studies have shown socio-economic differences in relation to dying at home, but more knowledge is needed in relation to preferences for place of death. Hence, on valid Danish register-based socio-economic data, we aimed to investigate whether demographic and socio-economic factors were associated with preference for dying at home.

Population-based, historic cohort study among 282 relatives of deceased patients who died of cancer in Denmark in 2006. Bereaved relatives were asked to state patient's preference concerning place of death at the beginning and end of the palliative period. These data were recently combined with updated, extensive demographic and socio-economic data from Danish national health registers. Generalised linear models were used modelling prevalence ratio (PR).

We found a significant positive association at the beginning of the palliative trajectory between preferring home death and being male (PR = 1.26 (95% CI: 1.00;1.58) (p = 0.048)) and a significant negative association between having medium income compared with high income (PR = 0.81 (95% CI 0.67;0.98) (p = 0.031)). At the end of the palliative trajectory, a significant negative association was found between preferring home death and living in a community with more than 100 000 inhabitants (PR = 0.63 (95% CI 0.45;0.89) (p = 0.008)) compared with living in communities with less than 10 000 inhabitants.

The study showed that socio-economic factors such as gender, level of income and size of community were associated with preference for dying at home. Hence, this study qualifies prior studies on preferences for end-of-life care and advocates for a more nuanced picture of the subject. Advocacy in end-of-life nursing recommends optimising active listening and communication skills striving towards more patients' preferences in all settings may be heard and fulfilled.