Reasons why palliative and terminally ill patients do not die at home with end-of-life home care or in a hospice, but in the hospital: a single-centre study.

backgroundIn the final stages of life, patients discuss their wishes regarding their preferred location of death. However, this preferred location is not always the actual place of death. This study explores why palliative and terminal patients die in the hospital instead of their preferred location.

methodsThis is an exploratory retrospective record review of adult palliative and terminal patients who died in 2023 in Gelre Hospitals Apeldoorn, the Netherlands, while waiting for terminal care at home or in hospices. Data were retrieved from electronic patient records, after which the reasons for not dying at the preferred location were analysed.

results74 patients were included, comprising 54.1% women, with a mean age of 78.2 years (SD 11.0). The most common reasons why patients did not die at their preferred location were sudden deterioration of health status (31%), hospice waiting lists (27%), and transfer delays (21%). Other reasons include uncertainty regarding the care location, failure to mark the terminal phase, and waiting for responses from preferred care locations. Delays in the transfer process due to the intervening weekend also seemed to play a role.

conclusionsSudden health deterioration and waiting lists at hospices seem to be the main reasons why patients die in the hospital instead of at their preferred location. The findings provide a starting point for formulating potential solutions to honour patients' wishes more often and enhance the quality of end-of-life care in our hospital-and potentially in other hospitals as well.