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Molly Walker from MedPage Today conducted email interviews with several palliative care experts to understand why so many patients die away from the home. 

 In talking to experts, Walker found that both patients and doctors are uncomfortable speaking about death and dying head on. In the article summarizing her findings, available here, Walker writes: 

 How to have end-of-life conversations “was not traditionally taught in medical schools,” leaving many doctors at a loss for how to speak to these issues, or interact with patients and families in such situations. “Physicians often assume people want ‘everything done,’ so what typically happens is that patients end up in the hospital or with an advancing illness, they may not even realize they may be nearing the end of life.”

No one wants to die if they don't have to, but if death is understood to be inevitable, there are many who prefer a natural death rather than an institutionalized fight to the finish with disease. 

Walker also finds that many patients see dying at home as "surrendering to death" as an un-hopeful alternative to dying in a hospital. These findings may not be surprising to hospice and palliative care workers who deal with the issues of family planning, coping with death and other end of life issues on a day-to-day basis. Walker concludes that increasing education and public awareness will help patients and physicians talk more openly about end of life care.