ObjectivesThe majority of people would prefer to die at home and the stated intentions of both statutory and voluntary healthcare providers aim to support this. This service evaluation compared the preferred and actual place of death of patients known to a specialist community palliative care service.DesignAll deaths of patients (n=2176) known to the specialist palliative care service over a 5-year period were examined through service evaluation to compare the actual place of death with the preferred place of death previously identified by the patient. Triggers for admission were established when the patients did not achieve this preference.ResultsBetween 2009 and 2013, 73% of patients who expressed a choice about their preferred place of death and 69.3% who wanted to die at home were able to achieve their preferences. During the course of their illness, 9.5% of patients changed their preference for place of death. 30% of patients either refused to discuss or no preference was elicited for place of death.ConclusionsDirect enquiry and identification of preferences for end-of-life care is associated with patients achieving their preference for place of death. Patients whose preferred place of death was unknown were more likely to be admitted to hospital for end-of-life care.

The perceived lack of social support for patients dying at home is a significant trigger for admission to a hospice. The provision of sitters to support patients dying at home may ensure people achieve their preference. Commissioners consider preferred place of care to be a marker of quality, but clinical events that precipitate admission are often outside the influence of the palliative care team.

The majority of people would prefer to die at home, yet more than 50% of the UK population die in hospital. NHS policy and specialist palliative care services encourage the individual to choose and expect to experience end-of-life care in their preferred place. Commissioners for specialist services use place of death as a quality marker against funding provided.MethodA proforma was completed upon the death of every patient referred to the service in 2009–10. Information captured included preferred and actual place of death, aspects surrounding end-of-life care including any triggers for admission.Results788 patients known to the hospice died, the median number of days patients were known was 83 and mean 160.7% of deaths were from non-malignant disease.55% of patients specified their preferred place of death was their current place of living (home, residential or nursing home and prison). 67% of patients who expressed this preference achieved this. 14% of patients identified they would prefer to be admitted as an inpatient to the hospice for end-of-life care, 81% achieved this. New conditions and lack of social support were significant triggers for admission.ConclusionThe proportion of patients achieving their preferences for home and inpatient hospice with this community service compares favourably with results reported. Achieving preferences is a reflection of healthy community services as a whole. Despite the more unpredictable time course of non-malignant illnesses, the majority of these patients were able to achieve their preferences for end-of-life care.This audit provided basic information for discussion with our commissioners. Breakdown by primary care team and cause of admission enabled the service to consider targets for future education and activity by looking at triggers for acute admissions as starting points to change health behaviour and target social care.

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