Abarshi E, Echteld M, Van den Block L, Donker G, Deliens L, Onwuteaka-Philipsen B. Transitions between care settings at the end of life in The Netherlands: results from a nationwide study. Palliat Med. 2010; 24:(2)166-174

Bone AE, Gao W, Gomes B Factors associated with transition from community settings to hospital as place of death for adults aged 75 and older: a population-based mortality follow-back survey. J Am Geriatr Soc. 2016; 64:(11)2210-2217

Critical Appraisal Skills Programme. CASP checklists. 2018. (accessed 26 June 2019)

Centre for Reviews and Dissemination. Systematic reviews. 2008. (accessed 26 June 2019)

Choice in End of Life Programme Board. What's important to me. A review of choice in end of life care. 2015. (accessed 22 June 2019)

Collis E, Al-Qurainy R. Care of the dying patient in the community. BMJ. 2013; 347

Coombs MA, Parker R, de Vries K. Managing risk during care transitions when approaching end of life: a qualitative study of patients' and health care professionals' decision making. Palliat Med. 2017; 31:(7)617-624

De Korte-Verhoef MC, Pasman HR, Schweitzer BP, Francke AL, Onwuteaka-Philipsen BD, Deliens L. General practitioners' perspectives on the avoidability of hospitalizations at the end of life: a mixed-method study. Palliat Med. 2014; 28:(7)949-958

De Korte-Verhoef MC, Pasman HRW, Schweitzer BPM, Francke AL, Onwuteaka-Philipsen BD, Deliens L. How could hospitalisations at the end of life have been avoided? A qualitative retrospective study of the perspectives of general practitioners, nurses and family carers. PLoS One. 2015; 10:(3)

Department of Health. End of life care strategy. Promoting high quality care for all adults at the end of life. 2008. (accessed 26 June 2018)

Department of Health. One year on: the government response to the review of choice in end of life care. 2017. (accessed 26 June 2018)

Dying Matters. Frequently asked questions. 2017. (accessed 1 July 2018)

Gardiner C, Ward S, Gott M, Ingleton C. Economic impact of hospitalisations among patients in the last year of life: an observational study. Palliat Med. 2014; 28:(5)422-429

Gill TM, Gahbauer EA, Han L, Allore HG. The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people. BMJ. 2015; 350

Gomes B, Higginson IJ, Calanzani N Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann Oncol. 2012; 23:(8)2006-2015

Gott M, Frey R, Robinson J The nature of, and reasons for, ‘inappropriate’ hospitalisations among patients with palliative care needs: a qualitative exploration of the views of generalist palliative care providers. Palliat Med. 2013; 27:(8)747-756

Hanratty B, Holmes L, Lowson E Older adults' experiences of transitions between care settings at the end of life in England: a qualitative interview study. J Pain Symptom Manage. 2012; 44:(1)74-83

Henson LA, Higginson IJ, Daveson BA ‘I'll be in a safe place’: a qualitative study of the decisions taken by people with advanced cancer to seek emergency department care. BMJ Open. 2016; 6:(11)

Higginson IJ, Sarmento VP, Calanzani N, Benalia H, Gomes B. Dying at home—is it better: a narrative appraisal of the state of the science. Palliat Med. 2013; 27:(10)918-924

Higginson IJ, Daveson BA, Morrison RS Social and clinical determinants of preferences and their achievement at the end of life: prospective cohort study of older adults receiving palliative care in three countries. BMC Geriatr. 2017; 17:(1)

Hunt KJ, Shlomo N Addington-Hall J. End-of-life care and achieving preferences for place of death in England: results of a population-based survey using the VOICES-SF questionnaire. Palliat Med. 2014; 28:(5)412-421

Jack B, O'Brien M. Dying at home: community nurses' views on the impact of informal carers on cancer patients' place of death. Eur J Cancer Care (Engl). 2010; 19:(5)636-642

Krawczyk M, Gallagher R. Communicating prognostic uncertainty in potential end-of-life contexts: experiences of family members. BMC Palliat Care. 2016; 15:(1)

Lakasing E, Kulkarni S, Sparkes C, RaviChander R. A practice-based survey of patients dying in hospital: can we do more to support end-of-life care at home?. Br J Community Nurs. 2014; 19:(3)130-133

O'Brien M, Jack B. Barriers to dying at home: the impact of poor co-ordination of community service provision for patients with cancer. Health Soc Care Community. 2010; 18:(4)337-345

Office for National Statistics. National survey of bereaved people (VOICES) England 2015'. 2016. (accessed 26 June 2019)

Reyniers T, Houttekier D, Cohen J, Pasman HR, Deliens L, Deliens L. What justifies a hospital admission at the end of life? A focus group study on perspectives of family physicians and nurses. Palliat Med. 2014; 28:(7)941-948

Reyniers T, Deliens L, Pasman HR Reasons for end-of-life hospital admissions: results of a survey among family physicians. J Pain Symptom Manage. 2016; 52:(4)498-506

Seal K, Murray CD, Seddon L. Family stories of end-of-life cancer care when unable to fulfill a loved one's wish to die at home. Palliat Support Care. 2015; 13:(3)473-483

Smith AK, McCarthy E, Weber E Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff. 2012; 31:(6)1277-1285

Spilsbury K, Rosenwax L, Arendts G, Semmens JB. The impact of community-based palliative care on acute hospital use in the last year of life is modified by time to death, age and underlying cause of death. A population-based retrospective cohort study. PLoS One. 2017; 12:(9)

World Health Organization. Palliative care. 2018. (accessed 22 June 2019)

Yang N, Ornstein KA, Reckrey JM. Association between symptom burden and time to hospitalization, nursing home placement, and death among the chronically ill urban homebound. J Pain Symptom Manage. 2016; 52:(1)73-80

A review of the literature on family decision-making at end of life precipitating hospital admission

11 July 2019
Volume 28 · Issue 13


Around 70% of people would prefer to die at home, yet around 50% die in hospital, according to Dying Matters. In collaboration with a local hospice, a literature review was undertaken to address the question: ‘what factors precipitate admission to hospital in the last few days of a person's life for those who had expressed a preference to die at home?’ Four electronic databases were searched, with a date range of 2008 to 2018. After 80 articles were screened, 13 were included in the review. The findings identified a number of barriers experienced by people with non-cancer conditions nearing the end of life and their family carers, which inhibit the transition to end-of-life care. The findings suggest that hospice support for non-cancer patients with a deteriorating health trajectory needs to precede patient and family recognition that end-of-life care is needed.

This article sets out to answer the following question by reviewing relevant literature from 2008 to 2018: ‘what factors precipitate admission to hospital in the last few days of a person's life for those who had expressed a preference to die at home?’

The question was identified by a local hospice as an important question for non-cancer patients who, despite expressing a preference for a home death, frequently end up dying in hospital. Pressure group Dying Matters ( estimates that around 70% of people would prefer to die at home, yet around 50% die in hospital. Promoting patient choice in treatment, management and location of care, including place of death, is core to several UK and international policy drivers (Higginson et al, 2013; Choice in End of Life Programme Board, 2015; Department of Health (DH), 2017; World Health Organization, 2018). These policies are supported by initiatives designed to reshape primary and community care and to reduce hospital admission at the end of life (DH, 2008).

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