Place of death: Hobson’s Choice or patient choice?

Storey, Les; Pemberton, Chris; Howard, Anne; O’Donnell, Lee

doi:10.7748/cnp2003.05.2.4.33.c72

Cited by 28 publications

(21 citation statements)

References 3 publications

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“…Many patients, including those discharged after an admission, do not manage to stay at home and instead die as inpatients 3 6 19. A significant proportion of patients experience an emergency admission from home, after which it may not be possible to arrange discharge.…”

Section: Place Of Deathmentioning

confidence: 99%

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“Please, I want to go home”: ethical issues raised when considering choice of place of care in palliative care

Wheatley¹,

Baker

2007

Postgraduate Medical Journal

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Many palliative care patients would prefer to receive care, and to die, at home. Despite this many die in institutions. In response to this, politicians and charities have adopted policies aimed at increasing the opportunities for care and death at home. The need to discuss plans for discharge with most inpatients reinforces expectations of a choice of place of care. However, many palliative patients do not have a choice of care at home. This article will explore the circumstances in which patients are unable to choose home care and consider changes in clinical practice that can help to maximise choice. We shall argue that there is a distinction between the preferences of patients and the choices actually available to them. In attempting to make this distinction we advocate consideration of the balance between the ethical principles relevant to each case.

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Section: Place Of Deathmentioning

confidence: 99%

“…Studies have questioned patients early in their disease and later on, and longitudinal studies have followed patients through the course of their disease 4 – 6. There are also data from relatives about their loved ones’ wishes, obtained both before and after the patient’s death 4 5 7.…”

mentioning

confidence: 99%

“Please, I want to go home”: ethical issues raised when considering choice of place of care in palliative care

Wheatley¹,

Baker

2007

Postgraduate Medical Journal

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“…Programmes in support of this policy include a £6 million Government investment in education and training for district nurses (DNs) in palliative care, and an End of Life Care Strategy which is supporting the wider uptake of three initiatives: the Gold Standards Framework (GSF), the Liverpool Care Pathway, and Preferred Place of Care plans to enhance the choice of dying at home if patients wish. [1][2][3][4][5][6][7] These programmes are taking place in a time of major change in the organisation and delivery of primary care. In particular, the introduction of a new contract for NHS general practitioners (GP) and the reconfiguration of out-of-hours services have altered the activities of GPs, and may affect their role in the provision of palliative care.…”

Section: A Postal Survey Of London Gps Introductionmentioning

confidence: 99%

Roles, service knowledge and priorities in the provision of palliative care: a postal survey of London GPs

Burt¹,

Shipman

White

et al. 2006

Palliat Med

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ObjectivesTo explore general practitioners' (GPs) current involvement in and attitudes towards the provision of palliative care in primary care. MethodsPostal survey of 356 London-based GPs assessing attitudes towards palliative care provision, district nursing and specialist palliative care services, and priorities for future service development. Results 65%of GPs were currently providing palliative care to patients on their list; 72% agreed or strongly agreed palliative care was a central part of their role. 27% wanted to hand care over to specialists. Most GPs (66%) disagreed with the statement that "palliative care is mainly district nursing (DN) work". Many were unaware of out of hours DN and specialist palliative care services. Multivariable analysis found four GP characteristics (larger practice size, more years experience as a GP, receipt of palliative care education, and current provision of 4 palliative care) were associated with agreement that palliative care was central to a GPs' role. ConclusionA minority of NHS GPs in London would rather have no involvement in palliative care in primary care. Knowledge of current services for palliative care is generally poor among GPs. These findings highlight potential gaps in services, particularly in small practices. Specialists will need to consider these factors in working with GPs to develop primary palliative care and to enable greater access to specialist palliative care.

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“…The shock and isolation expressed by participants illustrated the need for continuous professional support and not to assume that disease recurrence is less devastating news than the initial diagnosis. Another reported communication issue was on preferred place of care (Storey et al 2003). Here participants emphasised that where service users were transferred to hospice or hospital in the last weeks or days of life, their partners felt that decision-making was resource-led rather than based on quality-of-life assessments.…”

Section: Discussionmentioning

confidence: 99%

User Perspective on Palliative Care Services: Experiences of Middle-aged Partners Bereaved through Cancer Known to Social Work Services in Northern Ireland

Agnew¹,

Manktelow²,

Donaghy³

2008

Practice

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Place of death: Hobson’s Choice or patient choice?

Cited by 28 publications

References 3 publications

“Please, I want to go home”: ethical issues raised when considering choice of place of care in palliative care

“Please, I want to go home”: ethical issues raised when considering choice of place of care in palliative care

Roles, service knowledge and priorities in the provision of palliative care: a postal survey of London GPs

User Perspective on Palliative Care Services: Experiences of Middle-aged Partners Bereaved through Cancer Known to Social Work Services in Northern Ireland

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