Preferences for place of death if faced with advanced cancer: A population survey in England, Flanders, Germany, Italy, The Netherlands, Portugal and Spain

B. Gomes, I.J. Higginson, N. Calanzani, J. Cohen, L. Deliens, B.A. Daveson, D. Bechinger-English, C. Bausewein, P.L. Ferreira, F. Toscani, A. Meñaca, M. Gysels, L. Ceulemans, S.T. Simon, H.R.W. Pasman, G. Albers, S. Hall, F.E.M. Murtagh, D.F. Haugen, J. DowningJ. Koffman, F. Pettenati, S. Finetti, B. Antunes, Richard Harding

Research output: Contribution to journalArticlepeer-review

394 Citations (Scopus)



Cancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences for place of death cross-nationally.

A telephone survey of a random sample of individuals aged ≥16 in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We determined where people would prefer to die if they had a serious illness such as advanced cancer, facilitating circumstances, personal values and experiences of illness, death and dying.

Of 9344 participants, between 51% (95% CI: 48% to 54%) in Portugal and 84% (95% CI: 82% to 86%) in the Netherlands would prefer to die at home. Cross-national analysis found there to be an influence of circumstances and values but not of experiences of illness, death and dying. Four factors were associated with a preference for home death in more than one country: younger age up to 70+ (Germany, the Netherlands, Portugal, Spain), increased importance of dying in the preferred place (England, Germany, Portugal, Spain), prioritizing keeping a positive attitude (Germany, Spain) and wanting to involve family in decisions if incapable (Flanders, Portugal).

At least two-thirds of people prefer a home death in all but one country studied. The strong association with personal values suggests keeping home care at the heart of cancer EoLC.

Previous article in issue
Original languageEnglish
Pages (from-to)2006-2015
Number of pages10
JournalAnnals of Oncology
Issue number8
Early online date16 Feb 2012
Publication statusPublished - 1 Aug 2012

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 and Gao Wei, Joana Cadima and Vicky Simms for statistical advice. We also thank our colleagues from the project 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 as part of the project PRISMA(contract number: Health-F2-2008-201655). PRISMA was funded with the overall aim to co-ordinate high-quality international research into end-of-life cancer care. PRISMA aimed to provide evidence and guidance on best practice to ensure that research can measure and improve outcomes for patients and families. PRISMA activities aimed 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 and scientific director: Irene J Higginson. This article reflects only the authors' views and the European Commission is not liable for any use that may be made of the information contained therein.

The authors declare no conflict of interest.


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