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Where the Dying Live: A Systematic Review of Determinants of Place of End-of-Life Cancer Care

Mary Ann Murray
Valerie Fiset
Sandra Young
Jennifer Kryworuchko
ONF 2009, 36(1), 69-77 DOI: 10.1188/09.ONF.69-77

Purpose/Objectives: To describe the determinants of place of end-of-life (EOL) care for patients with cancer.

Data Sources: A systematic literature review of primary research studies (1997-2007) was conducted. Studies that investigated place of EOL care or identified place of EOL care in relation to outcomes were examined, their critical quality was appraised, and references were mapped.

Data Synthesis: Of the 735 articles identified, 39 (representing 33 studies) met inclusion criteria. Two main research designs emerged: large-scale epidemiologic reports and smaller descriptive studies. Findings suggest that factors related to the disease, the individual, and the care and social environment influence place of EOL care for patients with cancer. Social support, healthcare inputs (from services and programs and healthcare provider contact), and patient preferences were the most important factors.

Conclusions: Most patients with terminal cancer prefer home palliation; however, most die in an institution. The reasons are complex, with various determinants influencing decisions regarding place of EOL care.

Implications for Nursing: Findings may highlight evidence-based interventions to assist patients and families facing decisions regarding place of EOL care. A clearer understanding of factors that influence place of EOL care for patients with cancer could enhance healthcare policy and guide needs-based modifications of the healthcare system.

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