Open Access Research article

Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy

Debra A Howell1*, Eve Roman1, Helen Cox1, Alexandra G Smith1, Russell Patmore2, Anne C Garry3 and Martin R Howard4

Author Affiliations

1 Epidemiology and Genetics Unit, Department of Health Sciences, Seebohm Rowntree Building, University of York, YO10 5DD, UK

2 Department of Haematology, Queens Centre for Oncology and Haematology, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK

3 Palliative Medicine, North Yorkshire and York PCT, York, YO31 8HE, UK

4 Department of Haematology, York Hospital, Wigginton Road, York, YO31 8HE, UK

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BMC Palliative Care 2010, 9:9  doi:10.1186/1472-684X-9-9

Published: 1 June 2010

Abstract

Background

Haematological malignancies are a common, heterogeneous and complex group of diseases that are often associated with poor outcomes despite intensive treatment. Research surrounding end-of-life issues, and particularly place of death, is therefore of paramount importance, yet place of death has not been formally reviewed in these patients.

Methods

A systematic literature review and meta-analysis was undertaken using PubMed to identify all studies published between 1966 and 2010. Studies examining place of death in adult haematology patients, using routinely compiled morbidity and mortality data and providing results specific to this disease were included. 21 studies were identified with descriptive and/or risk-estimate data; 17 were included in a meta-analysis.

Results

Compared to other cancer deaths, haematology patients were more than twice as likely to die in hospital (Odds Ratio 2.25 [95% Confidence Intervals, 2.07-2.44]).

Conclusion

Home is generally considered the preferred place of death but haematology patients usually die in hospital. This has implications for patients who may not be dying where they wish, and also health commissioners who may be funding costly end-of-life care in inappropriate acute hospital settings. More research is needed about preferred place of care for haematology patients, reasons for hospital deaths, and how these can be avoided if home death is preferred.