Actual and preferred place of death of cancer patients. Results from the Italian survey of the dying of cancer (ISDOC)

Objective: To describe actual and preferred place of death of Italian cancer patients and to analyse the preferences met regarding the place of death. Design: Mortality follow back survey of 2000 cancer deaths, identified with a two stage probability sample representative of the whole country. Information on patients' experience was gathered from the nonprofessional caregiver with an interview. A section of the interview covered information on the actual and preferred place of death of the patients. Setting: 30 Italian local health districts randomly selected after stratification in four geographical areas. Participants: 1900 of 2000 (95.0%) caregivers of cancer deaths identified. Main outcome measures: Prevalence of actual and preferred places of death. Results: Valid interviews were obtained for 66.9% (n=1271) of the caregivers. Place of death was home for 57.9% of Italian cancer patients, hospital for 34.6%, hospice for 0.7%, nursing home for 6.5%, and ambulance for 0.4%. Wide and significant differences within Italy were seen (home deaths ranged between 94.0% in the south and 28.2% in the north east). Home was the preferred place of death for 93.5% of patients that expressed a preference, with minimal differences within the country (between 89.5% and 99.0%). Overall 67.1% of the sample died in the place where they preferred to die. Conclusions: Policymakers should encourage health services to focus on ways of meeting individual preferences on place of death. As home was the preferred place of death for most cancer patients, effective programmes to enable the patients to remain at home should be implemented.