Table of Contents
International Journal of Palliative Care
Volume 2014, Article ID 157536, 11 pages
Review Article

Why Did an Out-of-Hospital Shift of Death and Dying Occur in Canada after 1994?

1Faculty of Nursing, University of Alberta, Edmonton, AB, Canada T6G 2C9
2Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada T6G 2G4
3Family Medicine, University of Calgary, Calgary, AB, Canada T2N 4N1

Received 28 June 2013; Accepted 11 November 2013; Published 2 February 2014

Academic Editors: L. Deliens and R. Viola

Copyright © 2014 Donna M. Wilson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Canadian population mortality data reveal a significantly reduced proportion of deaths occurring in hospitals after 1994. Hospital deaths peaked at 80.5% in 1994, after a longstanding hospitalization-of-death trend in Canada. A decline in hospital-based death and dying has also occurred in some other countries. As the place of death can have multiple significant direct and indirect impacts on dying individuals, their families, and health services utilization and costs, it is important to understand factors for an out-of-hospital shift. An integrative review of Canadian print literature from 1995 was undertaken to identify these factors, with three themes emerging: (1) changes in health care and health system reforms after 1994 reduced both the availability and desirability of hospital-based care, (2) sociodemographic developments including aging of the population, increased multiculturalism, and diversity in accepted end-of-life care practices shifted place preferences, and (3) advances in palliative and end-of-life care, including a palliative care expansion out of hospital, supported nonhospital death, and dying processes. The period following 1994 was thus a time of major transformation during which the place of death and dying underwent important changes that supported and promoted a transition from hospital-based end-of-life care.