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Re-Examining the definition of location of Death in Health Services Research

Location of death in end-of-life health services research is typically defined using death certificate (DC) information (1–3). We wondered whether the traditional DC definition of “hospital death,” particularly for cancer patients, masks the extent of community-based care in the Canadian province of Nova Scotia. Although most people approaching the end of life express the desire to die out-of-hospital, traditional estimates indicate that very few do (4–7): estimates are that in Nova Scotia, 74 percent of cancer patients between 1992 and 1997 died in hospital (1). 
 
For health services research, it is important to understand that the final location of death is not necessarily the location of care during most of the end of life. Are people arriving in hospital during the very last days of their lives, their final terminal period, to die? If so, then it could lead to the assumption that they received more end-of-life hospital care than they actually did and mask the fact that many of them were able to stay out of the hospital and receive community-based care until their very last days. In this short report, we look at the location of death of adults who died of cancer as determined by DC information and as determined by provincial hospital discharge summaries, and we compare the results.