End of life at home in France in 2010: Results from a nationwide population survey

Introduction: A population-based follow-back survey has studied places and circumstances of last weeks of life in France. Methods: Physicians having certified the deaths were asked to fulfil a questionnaire for a representative sample of 14,999 people deceased in December 2009. We analysed the cases of people deceased or having spent their last days or weeks at home, when death was not sudden. Results: The physician was a GP in 80% of the 484 deaths at home. When death occurred, close kin/family were present in 83% of cases, one patient out of three was treated with opioids, one out of 20 with midazolam. During the last day, the patient had at least one very severe physical symptom, or one very severe psychological symptom, in 30% and 40% of cases, respectively. When the last week was spent at home ( n=444), the treatments were still devoted to cure in 20% of cases. Palliative-oriented treatments were set up for 69%. A hospital-at-home service or a palliative care support team were involved in the management of 25% and 16% of these cases. Hospitalisation occurred the day of the death in 8% of cases, in an emergency department once out of three times. Conclusion: Contrary to some countries, the percentage of death at home has been stable for the last two decades. To increase this figure, more supports to relatives and professionals are required, and quality of these carers should be monitored.