Dynamic Preferences for Site of Death Among Patients With Advanced Obstructive Pulmonary Disease, Chronic Heart Failure, or Chronic Renal Failure

CONTEXT: To die at the preferred site is a key principle of a good OBJECTIVES: To examine one-year stability of preferences for site of patients with advanced chronic organ failure, and to assess agreement actual site of death and the site patients indicated in advance as their preferred site. METHODS: Clinically stable outpatients (n=265) with chronic obstructive pulmonary disease, chronic heart failure, or chronic failure were visited at home at baseline and four, eight, and 12 months baseline to assess their preferred site of death. One-year follow-up was completed by 77.7% of the patients. A bereavement interview was done closest relative of patients who died within two years after baseline 24.9%) to assess their actual site of death. RESULTS: During one-year 61.2% of the patients changed their preference for site of death. During interview before their death, 51.5% reported to prefer to die at home. A considerable portion of the patients (57.6%) died in the hospital, and the patients died at the site they reported previously as their (kappa=0.07, P=0.42). CONCLUSION: Preferences for site of death may patients with advanced chronic organ failure. Future studies should whether and to what extent discussing the possibilities for the site of end-of-life care as a part of advance care planning can prepare patients relatives for in-the-moment decision making and improve end-of-life REGISTRATION: NTR 1552 Dutch Trial Register.