TY - JOUR T1 - Place of death — how much does it matter? JF - British Journal of General Practice JO - Br J Gen Pract SP - 229 LP - 231 DO - 10.3399/bjgp08X279724 VL - 58 IS - 549 AU - Stephen Barclay AU - Antony Arthur Y1 - 2008/04/01 UR - http://bjgp.org/content/58/549/229.abstract N2 - Increasing patient choice is at the heart of current UK health service policy. At the end of life the focus is on eliciting patients' preferences for where end-of-life care is delivered, facilitating death at home when desired, and preventing crisis admissions in the last few days of life.1Less than one-fifth (18.5%) of deaths from all causes in England and Wales currently occur at home. More than half of all deaths (58.3%) occur in hospital, with evidence of a slow but steady decline in deaths occurring at home and a rising proportion of deaths in hospital. Figure 1 shows data for cancer deaths from 1993 to 2005 from the Office for National Statistics (ONS).Figure 1 Place of death for cancer patients in England and Wales 1993–2005.There is a mismatch between patients' preferred and actual place of death. Cross-sectional studies of patients,2,3 their informal carers,4 and the lay public5 reveal a majority preference for death at home: for most of us it is the natural place that death should come, reflecting who we are and what home and family means. Such preferences are not categorical, but are usually stronger or weaker leanings in one direction or another, qualified by uncertainty about the impact of future events.6Conditions at three levels must be met for palliative care at home to be successful. Personal factors include the patient's desire to remain at home, their attitude towards death and dying, and the impact of their illness in … ER -