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Objectives: Congruence between the preferred and actual place of death is recognised as an important quality indicator in end-of-life care. However, there may be complexities about preferences that are ignored in summary congruence measures. This article examined factors associated with preferred place of death, actual place of death, and congruence for a sample of patients who had received specialist palliative care in the last three months of life in Ireland. Methods: This article analysed merged data from two previously published mortality follow-back surveys: Economic Evaluation of Palliative Care in Ireland (EEPCI); Irish component of International Access, Rights and Empowerment (IARE I). Logistic regression models examined factors associated with (a) preferences for home death versus institutional setting, (b) home death versus hospital death, and (c) congruent versus non-congruent death. Setting: Four regions with differing levels of specialist palliative care development in Ireland. Participants: Mean age 77, 50% female/male, 19% living alone, 64% main diagnosis cancer. Data collected 2011-2015, regression model sample sizes: n = 342-351. Results: Congruence between preferred and actual place of death in the raw merged dataset was 51%. Patients living alone were significantly less likely to prefer home versus institution death (OR 0.389, 95%CI 0.157-0.961), less likely to die at home (OR 0.383, 95%CI 0.274-0.536), but had no significant association with congruence. Conclusions: The findings highlight the value in examining place of death preferences as well as congruence, because preferences may be influenced by what is feasible rather than what patients would like. The analyses also underline the importance of well-resourced community-based supports, including homecare, facilitating hospital discharge, and management of complex (eg, non-cancer) conditions, to facilitate patients to die in their preferred place. [ABSTRACT FROM AUTHOR]

Background: Economic evaluation of palliative care has been slow to develop and the evidence base remains small. Aim: This article estimates formal and informal care costs in the last year of life for a sample of patients who received specialist palliative care in three different areas in Ireland. Design: Formal care costs are calculated for community, specialist palliative care, acute hospital and other services. Where possible, a bottom-up approach is used, multiplying service utilisation by unit cost. Informal care is valued at the replacement cost of care. Setting/participants: Data on utilisation were collected during 215 'after death' telephone interviews with a person centrally involved in the care in the last year of life of decedents who received specialist palliative care in three areas in Ireland with varying levels of specialist palliative care. Results: Mean total formal and informal costs in the last year of life do not vary significantly across the three areas. The components of formal costs, however, do vary across areas, particularly for hospital and specialist palliative care in the last 3 months of life. Conclusion: Costs in the last year of life for patients in receipt of specialist palliative care are considerable. Where inpatient hospice care is available, there are potential savings in hospital costs to offset specialist palliative care inpatient costs. Informal care accounts for a high proportion of costs during the last year of life in each area, underlining the important role of informal caregivers in palliative care. [ABSTRACT FROM AUTHOR]

Background: In the context of limited resources, evidence on costs and cost-effectiveness of alternative methods of deliveringhealth-care services is increasingly important to facilitate appropriate resource allocation. Palliative care services have been expandingworldwide with the aim of improving the experience of patients with terminal illness at the end of life through better symptomcontrol, coordination of care and improved communication between professionals and the patient and family.Aim: To present results from a comprehensive literature review of available international evidence on the costs and cost-effectivenessof palliative care interventions in any setting (e.g. hospital-based, home-based and hospice care) over the period 2002-2011.Design: Key bibliographic and review databases were searched. Quality of retrieved papers was assessed against a set of 31 indicatorsdeveloped for this review.Data Sources: PubMed, EURONHEED, the Applied Social Sciences Index and the Cochrane library of databases.Results: A total of 46 papers met the criteria for inclusion in the review, examining the cost and/or utilisation implications of apalliative care intervention with some form of comparator. The main focus of these studies was on direct costs with little focus oninformal care or out-of-pocket costs. The overall quality of the studies is mixed, although a number of cohort studies do undertakemultivariate regression analysis.Conclusion: Despite wide variation in study type, characteristic and study quality, there are consistent patterns in the results.Palliative care is most frequently found to be less costly relative to comparator groups, and in most cases, the difference in cost isstatistically significant. [ABSTRACT FROM AUTHOR]