Skip to main content

01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Palliative Care 1/2014

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

BMC Palliative Care > Ausgabe 1/2014
Natalia Calanzani, Katrien Moens, Joachim Cohen, Irene J Higginson, Richard Harding, Luc Deliens, Franco Toscani, Pedro L Ferreira, Claudia Bausewein, Barbara A Daveson, Marjolein Gysels, Lucas Ceulemans, Barbara Gomes
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-684X-13-48) contains supplementary material, which is available to authorized users.
Katrien Moens, Joachim Cohen, Irene J Higginson, Richard Harding, Luc Deliens, Franco Toscani, Pedro L Ferreira, Claudia Bausewein, Barbara A Daveson, Marjolein Gysels, Lucas Ceulemans and Barbara Gomes contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

BG and NC coordinated the development and implementation of the interviews carried out by BMG Research and ZEM University of Bonn. BAD, RH and IJH aided this process and the commissioning of the study. NC conducted the data analysis supervised by BG and JC. NC took the main responsibility for writing the manuscript. KM helped to draft the manuscript and aided the development of the idea behind this paper along with BG and JC. NC, JC, LD, FT, PLF, CB, BAD, RH, IJH, LC and BG contributed to survey development. All authors took part in the interpretation of findings and drafting of the manuscript. All authors read and approved the final manuscript.



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.
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2014

BMC Palliative Care 1/2014 Zur Ausgabe

Neu im Fachgebiet AINS

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update AINS und bleiben Sie gut informiert – ganz bequem per eMail.