Barriers to hospital-at-home acceptance: a systematic review of reasons for patient refusal.

Background: Hospital-at-home (H@H) models have gained recognition as a safe and potentially cost-effective solution for the current rising global healthcare needs. However, despite these models' potential, their adoption has been limited partly due to patients refusing care at home. This systematic review analyses the reasons behind their refusal. Methods: We searched five databases: Embase, Google Scholar, PubMed, Scopus, and Web of Science, limiting our search to papers from 2005 to 2024. Our search focused on papers reporting patient-provided reasons for declining treatment in a H@H setting without language or country restrictions. In addition to reasons for refusal, we extracted patient demographics and predictors for refusal to ensure a broad understanding of the factors influencing patient decisions. The quality of the studies included was evaluated using the Mixed Methods Appraisal Tool (MMAT) version 2018. Results: From the 1,067 articles identified, seven met our inclusion criteria. The papers reported reasons from 418 patients participating in diverse H@H models from the United States, United Kingdom, Spain, and Singapore, primarily focusing on acute home-based care. The most common reasons for declination included concerns about model effectiveness, safety at home, preference for in-hospital care, physician advice, family burden, and visitor concerns. Additionally, common significant demographic factors associated with decliners were the enrollment site, partnership or marital status, risk of adverse outcomes, and previous healthcare utilization. Conclusions: Understanding patients' motivations for declining H@H is crucial for its successful implementation. Targeted communication strategies and collaboration between healthcare providers are paramount to ensure that patients understand the benefits and safety of H@H models. Future research should explore effective communication and engagement techniques to address patient apprehensions and broaden H@H adoption.