Choosing care homes as the least preferred place to die: A cross-national survey of public preferences in seven European countries

N. Calanzani, K. Moens, J. Cohen, I.J. Higginson, Richard Harding, L. Deliens, F. Toscani, P.L. Ferreira, C. Bausewein, B.A. Daveson, M. Gysels, L. Ceulemans, B. Gomes

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)



Care homes are increasingly becoming places where people spend the final stages of their lives and eventually die. This trend is expected to continue due to population ageing, yet little is known about public preferences regarding this setting. As part of a larger study examining preferences and priorities for end of life care, we investigated the extent to which care homes are chosen as the least preferred place of death, and the factors associated with this negative preference.

We conducted a cross-sectional telephone survey among 9,344 adults from random private households in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We asked participants where they would least prefer to die in a situation of serious illness with less than one year to live. Multivariate binary logistic regressions were used to identify factors associated with choosing care homes as the least preferred place of death in each country.

Care homes were the most frequently mentioned least preferred place of death in the Netherlands (41.5%), Italy and Spain (both 36.7%) and the second most frequent in England (28.0%), Portugal (25.8%), Germany (23.7%) and Flanders (18.9%). Only two factors had a similar and significant effect on the least preferred place of death in more than one country. In Germany and the Netherlands those doing housework were less likely to choose care homes as their least preferred place (AOR 0.72; 95% CI:0.54-0.96 and AOR 0.68; 95% CI:0.52-0.90 respectively), while those born in the country where the survey took place were more likely to choose care homes (AOR 1.77; 95% CI:1.05-2.99 and AOR 1.74; 95% CI:1.03-2.95 respectively). Experiences of serious illness, death and dying were not associated with the preference.

Our results suggest it might be difficult to promote care homes as a good place to die. This is an urgent research area in order to meet needs and preferences of a growing number of older people with chronic, debilitating conditions across Europe. From a research perspective and in order to allow people to be cared for and die where they wish, our findings highlight the need to build more in depth evidence on reasons underlying this negative preference.
Original languageEnglish
Article number48
Pages (from-to)1-11
Number of pages11
JournalBMC Palliative Care
Publication statusPublished - 23 Oct 2014

Bibliographical note


We are most grateful to all the survey participants. We thank the European Commission for the financial support needed to undertake this study; BMG Research and ZEM University of Bonn for assistance in survey administration and data collection; Gao Wei, Joana Cadima and Vicky Simms for statistical advice. We also thank our colleagues from PRISMA including the scientific committee who contributed to discussions and scientific review of the survey, namely Hamid Benalia, Emma Bennett, Lucy Bradley, Noël Derycke, Martine de Vlieger, Let Dillen, Natalie Evans, Michael Echteld, Nancy Gikaara, Stein Kaasa, Johan Menten, Bregje Onwuteaka-Philipsen, Ana Barros Pinto, Robert Pool, Richard A. Powell, Miel Ribbe, Katrin Sigurdardottir, Bart Van den Eynden, Paul Vanden Berghe and Trudie van Iersel. We thank Susana Bento, Carolina Comabella, Filomena Ferreira, Grethe Iversen, Carmen López-Dóriga, Constanze Rémi, Christian Schulz and Wessex Translations for their work translating and backtranslating the questionnaires. The invaluable work of Ron Irwin, Sian Best and Mike Gover at King’s College London is also highly appreciated.

This work was supported by the European Commission’s Seventh Framework Programme [contract number: Health-F2-2008-201655]. PRISMA was funded by the European Commission’s Seventh Framework Programme with the overall aim to co-ordinate high-quality international research into end of life cancer care. PRISMA aims to provide evidence and guidance on best practice to ensure that research can measure and improve outcomes for patients and families. PRISMA activities aim to reflect the preferences and cultural diversities of citizens, the clinical priorities of clinicians, and appropriately measure multidimensional outcomes across settings where end–of-life care is delivered. Principal Investigator: Richard Harding. Scientific Director: Irene J Higginson. This article reflects only the author’s views and the European Commission is not liable for any use that may be made of the information contained therein. The funders played no role in the design, execution, analysis and interpretation of data, or writing of the study.


Dive into the research topics of 'Choosing care homes as the least preferred place to die: A cross-national survey of public preferences in seven European countries'. Together they form a unique fingerprint.

Cite this