Intended for healthcare professionals


Is home always the best and preferred place of death?

BMJ 2015; 351 doi: (Published 07 October 2015) Cite this as: BMJ 2015;351:h4855
  1. Kristian Pollock, principal research fellow
  1. 1Nottingham University, School of Health Sciences, Queen’s Medical Centre, Nottingham NG7 2HA, UK
  1. kristian.pollock{at}
  • Accepted 11 August 2015

The current orthodoxy is that home is the best and preferred place of death for most people. Kristian Pollock questions these assumptions and calls for greater attention to improving the experience of dying in hospital and elsewhere

Place of death has become a key indicator of the quality of end of life care,1 2 underpinned by the conviction that most people would prefer to die at home.3 4 The institutional environment of acute hospital wards is considered an inappropriate and undesirable place in which to die,5 6 and there are concerns about poor quality of care.7 8 9 The need to reduce costs is a further incentive for reducing deaths in hospital.6 10 11 However, the evidence on patients’ preferences is unclear and conflicting. Regardless of preference, hospital will remain the most common place of death for the foreseeable future.6 12 Far from neglecting and disregarding the hospital as a site of terminal care, much greater thought and adequate resources must be directed to enabling hospitals to provide excellent support for dying patients and their families.

Is place of death a public priority?

Public surveys commonly report that around two thirds of respondents express a preference to die at home.3 6 13 14 15 However, there is considerable variation between studies. A substantial number of people do not specify a preference,16 and there is rarely an option for “it depends” or “does not matter.”17 The context and framing of the questions will shape the nature of responses, and studies vary in their design and quality.3

Public surveys, particularly among people who are young and healthy, may not accurately predict how individuals will feel when eventually confronted with their impending death.10 Notably, recent surveys indicate that although home may be selected as the preferred location, the place …

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