Where people die in Victoria

Factors that Promote Success in Home Palliative Care: A Study of a Large Suburban Palliative Care Practice

It has been repeatedly shown that most people would prefer to die in their own homes. However, many factors affect the feasibility of this choice. This study retrospectively examined the medical and nursing charts of 402 cancer patients who wished to die at home and had been referred to a palliative care service. Of those reviewed, 223 (55%) died at home, while 179 died in hospitals. The presence of more than one caregiver, an increased length of time between diagnosis and referral to a palliative care physician, an increased length of time under that physician's care, older age at referral, home ownership, and race were all significantly associated with home death, as were certain cancer diagnoses. The most compelling of these predictive factors have formed the basis for an evaluation tool, soon to be validated, to help palliative health professionals assess the viability of home-based palliative care culminating in a home death.

Determinants of Congruence between the Preferred and Actual Place of Death for Terminally Ill Cancer Patients

A prospective cohort study was conducted to explore the extent of congruence and to identify the determinants of congruence between the preferred and actual place of death of terminally ill cancer patients. A total of 180 terminally ill cancer patients were enrolled (87% response rate) and 127 died during the one-year study period. Nearly 90% of the subjects preferred to die at home. One-third achieved their preference for place of death. The kappa value of congruence (κ=0.11, 95% confidence interval=0.05–0.17) indicated poor to slight agreement between the preferred and actual place death. Important determinants of congruence between the preferred and actual place of death for terminally ill cancer patients included rehospitalisation and receiving hospice home care during the final days of life, perceived ability for family to help achieve preferred place of death, and residence in New Haven County.

Conclusions

This study directly confirms that the degree of congruence between the preferred and actual place death is unsatisfactory. Clinical interventions and health policies need to be developed to assist terminally ill cancer patients who may not be able to achieve their preference for place of end-of-life care and death.

Predictors of Death in the Hospital for Patients with Chronic Serious Illness

BACKGROUND

Most people prefer to die at home, yet most do not. Understanding factors associated with terminal hospitalization may inform interventions to improve care.

OBJECTIVE

Among patients with chronic illness receiving care in a multihospital healthcare system, we identified the following: (1) predictors of death in any hospital; (2) predictors of death in a hospital outside the system; and (3) trends from 2010 to 2015.

DESIGN

Retrospective cohort using death certificates and electronic health records. Settings/Subjects: Decedents with one of nine chronic illnesses.

RESULTS

Among 20,486 decedents, those most likely to die in a hospital were younger (odds ratio [OR] 0.977, confidence interval [CI] 0.974-0.980), with more comorbidities (OR 1.188, CI 1.079-1.308), or more outpatient providers (OR 1.031, CI 1.015-1.047); those with cancer or dementia, or more outpatient visits were less likely to die in hospital. Among hospital deaths, patients more likely to die in an outside hospital had lower education (OR 0.952, CI 0.923-0.981), cancer (OR 1.388, CI 1.198-1.608), diabetes (OR 1.507, CI 1.262-1.799), fewer comorbidities (OR 0.745, CI 0.644-0.862), or fewer hospitalizations within the system during the prior year (OR 0.900, CI 0.864-0.938). Deaths in hospital did not change from 2010 to 2015, but the proportion of hospital deaths outside the system increased (p < 0.022).

CONCLUSIONS

Patients dying in the hospital who are more likely to die in an outside hospital, and therefore at greater risk for inaccessibility of advance care planning, were more likely to be less well-educated and have cancer or diabetes, fewer comorbidities, and fewer hospitalizations. These findings may help target interventions to improve end-of-life care.

Patterns of care at end of life for people with primary intracranial tumors: lessons learned

To determine the variability in processes of care in the last 6 months of life experienced by patients dying of primary intracranial tumors and potential predictors of place of death, a death-backwards cohort was assembled using historical data and 1,623 decedents were identified. 90 % of people had ≥ 1 admission to an acute care hospital and 23 % spent ≥ 3 months of their last 6 months of life in acute care. 44 % had ≥ 1 ER visits and 30 % were admitted ≥ 1 times to ICU. Only 18 % had a home visit by a physician. 10 % died at home but 49 % died in hospital, while 40 % died in a palliative care facility. Age, comorbidities, and being diagnosed with grade 4 astrocytoma were associated with greater burden of care. Level of care burden and age were associated with higher odds of dying in a treatment intensive place of death, being diagnosed with grade 4 astrocytoma had opposite effect. Despite valuable research efforts to improve the treatment of primary intracranial tumors that focus on biology, refinements to surgery, radiation, and chemotherapy, there is also room to improve aspects of care at the end of life situation. An integrative approach for this patients' population, from diagnosis to death, could potentially reduce the care burden in the final period on the health care system, patient's family and improve access to a better place of death.

Influences on place of death in Botswana

OBJECTIVE

There is an emerging body of research aimed at understanding the determinants of place of death, as where people die may influence the quality of their death. However, little is known about place of death for people of Southern Africa. This study describes place of death (home or hospital) and potential influencing factors (cause of death, age, gender, occupation, and district of residence).

METHOD

We collected the death records for years 2005 and 2006 for all adult non-traumatic deaths that occurred in Botswana, described them, and looked for associations using bivariate and multivariate analyses.

RESULTS

The evaluable sample consisted of 18,869 death records. Home deaths accounted for 36% of all deaths, and were predominantly listed with "unknown" cause (82.3%). Causes of death for hospital deaths were HIV/AIDS (49.7%), cardiovascular disease (13.8%), and cancer (6.6%). The mean age at the time of all deaths was 53.2 years (SD = 20.9); with 61 years (SD = 22.5) for home deaths and 48.8 years (SD = 18.6) for hospital deaths (p < .001). Logistic regression analysis revealed the following independent predictors of dying at home: unknown cause of death; female gender; >80 years of age; and residing in a city or rural area (p < .05).

SIGNIFICANCE OF RESULTS

A major limitation of this study was documentation of cause of death; the majority of people who died at home were listed with an unknown cause of death. This finding impeded the ability of the study to determine whether cause of death influenced dying at home. Future study is needed to determine whether verbal autopsies would increase death-certificate listings of causes of home deaths. These data would help direct end-of-life care for patients in the home.

Predictors of place of death for seniors in Ontario: a population-based cohort analysis

Place of death was determined for all 58,689 seniors (age > or = 66 years) in Ontario who died during fiscal year 2001/2002. The relationship of place of death to medical and socio-demographic characteristics was examined using a multinomial logit model. Half (49.2 %) of these individuals died in hospital, 30.5 per cent died in a long-term care facility, 9.6 per cent died at home while receiving home care, and 10.7 per cent died at home without home care. Co-morbidities were the strongest predictors of place of death (p < 0.0001). A cancer diagnosis increased the chances of death at home while receiving home care; seniors with dementia were most likely to die in LTC facilities; and those with major acute conditions were most likely to die in hospitals. Higher socio-economic status was associated with greater probability of dying at home but contributed little to the model. Appropriate planning and resource allocation may help move place of death from hospitals to nursing homes or the community, in accordance with individual preferences.

Where people die: a multilevel approach to understanding influences on site of death in America

Despite documented preferences for home death, the majority of deaths from terminal illness occur in hospital. To better understand variation in place of death, we conducted a systematic literature review and a multilevel analysis in which we linked death certificates with county and state data. The results of both components revealed that opportunities for home death are disproportionately found in certain groups of Americans; more specifically, those who are White, have greater access to resources and social support, and die of cancer. From the multilevel analysis, the higher the proportion minority and the lower the level of educational attainment, the higher the probability of hospital death while investment in institutional long-term care, measured by regional density of nursing home beds and state Medicaid payment rate, was associated with higher probability of nursing home death. These results reinforce the importance of both social and structural characteristics in shaping the end-of-life experience.

Predictors associated with the place of death in a country with increasing hospital deaths

OBJECTIVES

To evaluate the contribution of type of illness, socio-demographic factors, and area of residence to the place of death in a country with increasing hospital deaths.

DESIGN

Descriptive study of hospital deaths using a 10-year death registration database from the Korean National Statistical Office.

SETTING AND PARTICIPANTS

Through the National Vital Statistics System, 2,402,259 deaths were registered in Korea from 1992 to 2001.

MEASUREMENT AND MAIN RESULTS

There was a significant trend toward an increase in the proportion of hospital deaths, from 16.6% in 1992 to 39.9% in 2001. The proportion of deaths at home decreased over that period, from 72.9 to 49.2%. The risk of hospital death versus home death was lower for those aged 75 years and over (adjusted odds ratio: 0.212; 95% confidence interval: 0.210-0.214) compared with those <55 years, and for people who were highly educated (2.04; 2.02-2.06), had white-collar jobs (1.55; 1.54-1.57), and resided in areas with more available hospital beds (2.46; 2.42-2.51). Compared with other causes of death, the risk of dying in hospital was higher for patients with ischaemic heart disease (1.83; 1.79-1.86), cancer (1.25; 1.23-1.26) and chronic lower respiratory disease (1.21; 1.18-1.23).

CONCLUSIONS

Trends in place of death are influenced by available hospital beds, socio-demographic factors and the nature of the terminal disease, in a country with increasing hospital deaths. These associations should be viewed within the context of culture and local health care systems.

A study of home deaths in Japan from 1951 to 2002

Background

Several surveys in Japan have indicated that most terminally ill Japanese patients would prefer to die at home or in a homelike setting. However, there is a great disparity between this stated preference and the reality, since most Japanese die in hospital. We report here national changes in home deaths in Japan over the last 5 decades. Using prefecture data, we also examined the factors in the medical service associated with home death in Japan.

Methods

Published data on place of death was obtained from the vital statistics compiled by the Ministry of Health, Labor and Welfare of Japan. We analyzed trends of home deaths from 1951 to 2002, and describe the changes in the proportion of home deaths by region, sex, age, and cause of death. Joinpoint regression analysis was used for trend analysis. Logistic regression analysis was performed to identify secular trends in home deaths, and the impact of age, sex, year of deaths and cause of deaths on home death. We also examined the association between home death and medical service factors by multiple regression analysis, using home death rate by prefectures in 2002 as a dependent variable.

Results

A significant decrease in the percentage of patients dying at home was observed in the results of joinpoint regression analysis. Older patients and males were more likely to die at home. Patients who died from cancer were less likely to die at home. The results of multiple regression analysis indicated that home death was related to the number of beds in hospital, ratio of daily occupied beds in general hospital, the number of families in which the elderly were living alone, and dwelling rooms.

Conclusion

The pattern of the place of death has not only been determined by social and demographic characteristics of the decedent, but also associated with the medical service in the community.

Discrepancy in the preferences of place of death between terminally ill cancer patients and their primary family caregivers in Taiwan

There is a worldwide common preference for dying at home. However, death at home does not come without significant challenges and potential consequences for families. Given the interactive nature of decisions regarding the place of death, the family's perspective is important and needs to be investigated. The purposes of this study were to compare (1) Taiwanese terminally ill cancer patients' and their family caregivers' preferences for the patient's place of death; and (2) important factors that are considered in choosing the preferred place of death from both points of view. A total of 617 dyads of terminally ill cancer patients and their family caregivers were surveyed. The majority of both terminally ill cancer patients and their family caregivers preferred to die at home (61.0% and 56.9%, respectively). A higher proportion of the family caregivers indicated a preference for hospital death for the patients. There was a moderate association between the two respondents in the preferences of place of death. Results underscore discrepancies between patients and their families in the importance given to cultural concerns, quality of health care, worries of being a burden to others, lack of availability of families, relationships with health care providers, and being surrounded by the home environment. Effective interventions need to be developed which can lighten the caregiving burden and help families retain dying patients at home, avoid unnecessary re-hospitalizations and unfavorable hospital deaths, and improve accordance with the patient's wishes.

[Place of death: "Where do people die in Switzerland nowadays?"]

BACKGROUND

Official information on the place of death has not been collected by the Swiss Federal Office of Statistics since 1987. Thus, no statements can be made for the developments in Switzerland.

METHODS

Physicians from the German speaking part of Switzerland who had filled in a death certificate between June 1 and October 30, 2001 were sent a questionnaire about circumstances of the specific death case. The frequencies of the place of death (at home, in hospital, in home for elderly, in nursing home, other place) were compared with the official data of the years 1969 until 1986. Using logistic regressions predictors for the place of death were estimated.

RESULTS

In 2001 in the German speaking part of Switzerland death occurred most frequently in hospital (37.2% of all death cases) followed by a home for elderly (33.5%) and dying at home (22.7%). Relevant predictors for the place of death were cause of death, sex, marital status and partly religion. Whereas between 1969 and 1986 a development towards dying in institutions was found, between 1986 and 2001 the place of death shifted within the institutions from hospitals to homes for elderly.

CONCLUSION

The relevance of the home for elderly as the place of death will further grow in the future. To allow people to fulfill the tasks of caring for their relatives at home the ambulant emergency services will have to be augmented and relatives have to be motivated and supported.

The place of death of cancer patients: can qualitative data add to known factors?

Research on the distribution of cancer deaths by setting-hospital, hospice, home, other--is longstanding, but has been given fresh impetus in the UK by policy commitments to increase the proportion of deaths occurring in patients' homes. Studies of factors associated with the location of cancer deaths fall into two main categories: geo-epidemiological interrogations of routinely collected death registration data, and prospective and retrospective cohort studies of terminally ill cancer patients. This paper summarises the findings of these studies and considers the place of death factors that are generated in semi-structured interviews with 15 palliative care service providers working in the Morecambe Bay area of north-west England. These qualitative data are found not only to confirm and considerably enrich understanding of known factors, but also to bring new factors into view. New factors can be grouped under the headings: service infrastructure, patient and carer attitudes, and cultures of practice. Such an approach provides useful information for policy makers and practitioners in palliative care.

Place of death: hospital-based advanced home care versus conventional care. A prospective study in palliative cancer care

The purpose of this prospective nonrandomized study was to evaluate time spent at home, place of death and differences in sociodemographic and medical characteristics of patients, with cancer in palliative stage, receiving either hospital-based advanced home care (AHC), including 24-hour service by a multidisciplinary palliative care team or conventional hospital care (CC). Recruitment to the AHC group and to the study was a two-step procedure. The patients were assigned to either hospital-based AHC or CC according to their preferences. Following this, the patients were asked to participate in the study. Patients were eligible for the study if they had malignant disease, were older than 18 years and had a survival expectancy of 2-12 months. A total of 297 patients entered the study and 280 died during the study period of two and a half years, 117 in the AHC group and 163 in the CC group. Significantly more patients died at home in the AHC group (45%) compared with the CC group (10%). Preference for and referral to hospital-based AHC were not related to sociodemographic or medical characteristics. However, death at home was associated with living together with someone. Advanced hospital-based home care targeting seriously ill cancer patients with a wish to remain at home enable a substantial number of patients to die in the place they desire.

Place of death of Houston area residents with cancer over a two-year period

The majority of cancer patients wish to die at home. Improved understanding of place of death and its relevant demographic predictors is important for the planning of palliative cancer care programs. The purpose of this study was to determine the place and predictors of site of death in cancer patients in a major U.S. metropolitan area. Death certificate data over two years were analyzed for Houston area residents with cancer who died in the Houston area. Information was obtained on factors that might be associated with the place where cancer patients die. For the purpose of this study, we looked at the following variables: primary site of cancer (hematological, breast, genitourinary, gastrointestinal, lung, and other); black, white, Hispanic, or Asian; age at death; marital status; sex; whether or not veteran of U.S. armed forces; levels of education; and area of residency within the Houston area. Univariate and multivariate analyses were performed. The majority of patients died in the hospital (51-52% both years), with the next most frequently occurring group dying at home (34-35% both years). Stepwise multivariate analysis resulted in a 6-variable logistic regression model. In this model, the odds of dying in hospital were increased by a factor of 2.7 if the patient had a hematological cancer (P<0.0001), a factor of 1.6 if the patient lived in Harris County (P<0.0001), and a factor of 1.5 if the patient was black (P<0.0001). Further characterization of factors associated with increased risk of hospital death rate is needed and systems should be developed to enable the majority of cancer patients to access palliative care services in the multiple settings in which they die.

Place of death and its predictors for local patients registered at a comprehensive cancer center

PURPOSE

To help with planning of a palliative care program, we reviewed the place of death of patients who were registered at our comprehensive cancer center and explored factors that predicted death in the hospital versus death at home.

PATIENTS AND METHODS

A retrospective study was undertaken of local patients who were registered at the University of Texas M.D. Anderson Cancer Center and died during the 1997/1998 fiscal year. Data from the institutional tumor registry and from the State of Texas Bureau of Vital Statistics file were collected and analyzed. The main outcome measures were place of death, patient characteristics associated with place of death, and time from registration at the institution to death.

RESULTS

Of 1,793 local patients, 251 (14%) died at M.D. Anderson Cancer Center; the remaining 86% died elsewhere. A total of 617 (34%) died at home, and 929 (52%) died in an acute hospital setting (including M.D. Anderson). A total of 1,040 (58%) died within 2 years of registration. The risk of hospital death versus home death increased for patients with cancer at a hematologic site (odds ratio [OR], 4.4; 95% confidence interval [CI], 2.8 to 6.8) and black ethnicity (OR, 1.9; 95% CI, 1.4 to 2.6) and decreased for patients who paid with Medicare (OR, 0.71; 95% CI, 0.57 to 0.90).

CONCLUSION

Most patients died in an acute care hospital setting and within 2 years of registration. Our data show some predictors of hospital death for cancer patients and suggest that better hospital palliative care services and integrated palliative care systems that bridge community and acute hospitals are needed.

Time spent in hospital in the last six months of life in patients who died of cancer in Ontario

PURPOSE

To describe hospital bed utilization in the final 6 months of life in patients dying of cancer in Ontario, Canada.

PATIENTS AND METHODS

Hospital separation records were linked to a population-based cancer registry to identify factors associated with hospitalization in the 203,713 patients who died of cancer in Ontario between 1986 and 1998.

RESULTS

Between 1986 and 1998, 5.3% of all acute care beds in Ontario were devoted to the care of cancer patients in the last 6 months of life. The mean time spent in hospital in the last 6 months of life decreased from 34.3 days in 1986 to 22.7 days in 1998. Hospitalization rates increased exponentially during the last month of life. Patients younger than 50 years of age, women, and residents of poorer communities spent significantly longer in hospital than others. Hospitalization rates differed very little among the common solid tumors, but patients with CNS malignancies, the lymphomas, and the leukemias spent significantly longer in hospital than the other groups. There was significant interregional variations in hospitalization that were not explained by differences in case mix. There was a statistically significant inverse correlation between the rate of use of palliative radiotherapy and the hospital bed use in the county in which the patient resided.

CONCLUSION

The total time spent in hospital in the last 6 months of life has decreased over the last decade, but acute care hospitals continue to play a large role in the care of patients who are dying of cancer.

Factors associated with home versus institutional death among cancer patients in Connecticut

OBJECTIVE

To assess the relationships between home death and a set of demographic, disease-related, and health-resource factors among individuals who died of cancer.

DESIGN

Prospective cohort study.

SETTING

All adult deaths from cancer in Connecticut during 1994.

PARTICIPANTS

Six thousand eight hundred and thirteen individuals who met all of the following criteria: died of a cancer-related cause in 1994, had previously been diagnosed with cancer in Connecticut, and were age 18 and older at the time of death.

MEASUREMENT

Site of death.

RESULTS

Twenty-nine percent of the study sample died at home, 42% died in a hospital, 17% died in a nursing home, and 11% died in an inpatient hospice facility. Multivariate analysis indicated that demographic characteristics (being married, female, white, and residing in a higher income area), disease-related factors (type of cancer, longer survival postdiagnosis), and health-resource factors (greater availability of hospice providers, less availability of hospital beds) were associated with dying at home rather than in a hospital or inpatient hospice.

CONCLUSIONS

The implications of this study for clinical practice and health planning are considerable. The findings identify groups (men, unmarried individuals, and those living in lower income areas) at higher risk for institutionalized death-groups that may be targeted for possible interventions to promote home death when home death is preferred by patients and their families. Further, the findings suggest that site of death is influenced by available health-system resources. Thus, if home death is to be supported, the relative availability of hospital beds and hospice providers may be an effective policy tool for promoting home death.

Determinants of place of death for terminal cancer patients

Approximately two-third of cancer patients, when asked about the preferred place of death, wish to die in their own homes. However, the majority of deaths from cancers in most western countries occur in a hospital. When a person dies from other than sudden or traumatic causes, the death appears to be a function of a complex interplay of personal and cultural values and physical and medical factors, as well as various health care systems forces. This article reviews the determinants of place of death for terminal cancer patients from published studies in hopes of shedding light on the difficulties of dying patients to realize their preferences for place of death. These insights may contribute to modification of hospice care systems so health professionals will be more responsive to the needs of their dying patients to retain control and die with dignity and help health professionals achieve the proposed outcome of hospice care.

Where do patients with cancer die in Belfast?

BACKGROUND

Most patients with cancer prefer to die at home but the majority die in institutions.

AIM

To determine place of death for patients with cancer in Belfast, to examine changes over time and identify factors associated with place of death.

METHODS

A survey of deaths registered in Belfast over a six-month period for 1977, 1987 and 1997 identified patients dying from cancer. Epidemiological data included age, gender, malignancy, social class, marital status, area of residence and place of death.

RESULTS

Home deaths fell from 35% in 1977 to 28% in 1997. Hospital deaths fell from 50% in 1977 to 40% in 1987 rising to 42% in 1997. Hospice deaths rose from 13% in 1977 to 25% in 1987 falling to 23% in 1997. There was an association between place of death and age, marital status, type of cancer and area of residence, but not with social class or gender.

CONCLUSION

The majority of people fail to achieve a home death. Resources need to be targeted to those most at risk of an institutional death; females, the elderly, the unmarried, those with haematological malignancies and residents of South Belfast.

Place of death and access to home care services: are certain patient groups at a disadvantage?

Research indicates that fewer people are able to die at home than would wish to do so. Furthermore the ability to die at home is unequally distributed depending on patient characteristics. Unless factors associated with home deaths are identified and interventions are targeted accordingly, further general improvements in care support may only help those already at an advantage. This paper reviews research investigating the relation between patient characteristics and home deaths and considers whether these variables influence place of death because they are associated with differential access to services, focusing on access to palliative home care. Patients with informal carer support were both more likely to die at home and to access palliative home care. Provision of home care did not remove the dependence on informal carers in achieving home death, however. An important target in improving home death rates is therefore better support for informal carers overall. Older patients were both less likely to die at home and to access home care. Once in home care they no longer were less likely to die at home. Although age related needs require consideration, improved access to home care is therefore likely to increase home deaths for older people. Women were less likely to die at home than men, yet younger women may be more likely to access home care. There is some evidence to suggest that men were less efficient as carers, which may help explain why women were less likely to achieve home deaths, while making their referral to home care more likely. While home care may help redress the gender imbalance, men may also need to be encouraged and enabled to take on the carer role. Cancer patients in higher socioeconomic groups were both more likely to die at home and to access home care. Hence home deaths may increase by improving access for lower socioeconomic groups to the services available.

A population-based study of the coverage of cancer patients by hospice services

The aims were to determine the proportion of terminal cancer patients in South Australia who had involvement with a programme of hospice care, to identify the predictors of hospice involvement, and to consider the influence of hospice services, along with other variables, on the place of death. A file of patients of the State's hospice services who died in 1990 was compiled and linked to the population-based Central Cancer Register. We found that 1561 (56%) of the 2800 cancer patients who died in 1990 had care from a hospice service. Patients were less likely to be involved with a hospice service if they were 80 years or older, lived in a rural region, or had a haematological malignancy, and more likely to have hospice care if they had a survival time of more than six months, or were born in the UK or Europe. Patients of hospice services were more likely than other patients to die at home or in an inpatient hospice, and less likely to die in a nursing home or private hospital. A range of other factors were also found to be associated with place of death. We conclude that there has been a rapid acceptance of hospice care in South Australia, with a majority of the target population of cancer patients covered by services. Epidemiological research methods are useful for identifying gaps in the provision of care, and for determining the impact of various factors on where people die. This research is, therefore, important for the formulation and evaluation of policy for the delivery of terminal care.

Trends in the terminal care of cancer patients: South Australia, 1981-1990

BACKGROUND

The increasing numbers of cancer patients, the high costs of terminal care, and the development of palliative care services have led to a growing interest in patterns of terminal cancer care. These patterns are relevant to the formulation and evaluation of health services policy.

AIMS

To investigate trends in the place of death of South Australian cancer patients between 1981 and 1990, and to examine associations of socio-demographic and clinical variables with the place of death.

METHODS

Data relating to 2715 deaths attributed to cancer in 1990 were extracted from the Central Cancer Registry. To assess trends, these data were directly standardised to the age-sex distribution of cancer deaths in 1981 and 1985 which were investigated in a previous study. Unconditional logistic regression was used to investigate predictors of place of death.

RESULTS

The proportion of deaths which occurred in major metropolitan public hospitals decreased from 40% in 1981 to 28% in 1990. Conversely, the proportion which occurred in hospice units increased from 5% to 20% over the same period. There was a decline in the proportion of deaths which occurred in private hospitals, but there was no significant change in the proportion which occurred in country hospitals or nursing homes. The proportion of deaths at home remained around 14%. Associated with place of death were age, sex, type of malignancy, survival time from diagnosis to death, Aboriginality, and area of residence. Further research to assess the clinical appropriateness of terminal care patterns is suggested.