Preferred place of death for patients referred to a specialist palliative care service

Arnold, Elizabeth; Finucane, Anne; Oxenham, David

doi:10.1136/bmjspcare-2012-000338

Cited by 66 publications

(35 citation statements)

References 12 publications

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“…Looking very generally, however, the proportion of people we identified with a discussion about preferred place of death falls within the broad range (18.7-87%) reported in UK studies from palliative care settings. [42][43][44][45][46][47] The proportion of patients preferring hospital death was generally much higher in our study and much lower for home death than that reported in other studies of patients with cancer, where hospital death was often the least favoured option. 4 48 49 The proportion of people we identified who died in their preferred place was broadly comparable to other studies; 4 45 47-49 and others also reported that people taking part in discussions about place of death are less likely to die in hospital.…”

Section: Discussioncontrasting

confidence: 68%

Preferred and actual place of death in haematological malignancy

Howell

Wang

Roman

et al. 2015

BMJ Support Palliat Care

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ObjectivesHome is considered the preferred place of death for many, but patients with haematological malignancies (leukaemias, lymphomas and myeloma) die in hospital more often than those with other cancers and the reasons for this are not wholly understood. We examined preferred and actual place of death among people with these diseases.MethodsThe study is embedded within an established population-based cohort of patients with haematological malignancies. All patients diagnosed at two of the largest hospitals in the study area between May 2005 and April 2008 with acute myeloid leukaemia, diffuse large B-cell lymphoma or myeloma, who died before May 2010 were included. Data were obtained from medical records and routine linkage to national death records.Results323 deceased patients were included. A total of 142 (44%) had discussed their preferred place of death; 45.8% wanted to die at home, 28.2% in hospital, 16.9% in a hospice, 5.6% in a nursing home and 3.5% were undecided; 63.4% of these died in their preferred place. Compared to patients with evidence of a discussion, those without were twice as likely to have died within a month of diagnosis (14.8% vs 29.8%). Overall, 240 patients died in hospital; those without a discussion were significantly more likely to die in hospital than those who had (p≤0.0001). Of those dying in hospital, 90% and 75.8% received haematology clinical input in the 30 and 7 days before death, respectively, and 40.8% died in haematology areas.ConclusionsMany patients discussed their preferred place of death, but a substantial proportion did not and hospital deaths were common in this latter group. There is scope to improve practice, particularly among those dying soon after diagnosis. We found evidence that some people opted to die in hospital; the extent to which this compares with other cancers is of interest.

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Section: Discussioncontrasting

confidence: 68%

Preferred and actual place of death in haematological malignancy

Howell

Wang

Roman

et al. 2015

BMJ Support Palliat Care

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“…Our findings are consistent with those of Arnold et al . who found patients who were unable to express a preferred place were more likely to die in hospital [21]. …”

Section: Discussionmentioning

confidence: 99%

Establishing a Supportive Care Register Improves End-of-Life Care for Patients with Advanced Chronic Kidney Disease

Harrison

Clipsham

Cooke

et al. 2015

Nephron

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Background: End-of-life care for patients with advanced chronic kidney disease (CKD) is recognised as an important area for improvement. These patients have a significant mortality and, although some is unpredictable, there is a role for the nephrology multi-disciplinary team (MDT) and palliative care physicians to engage in advance care planning and support patients to discuss their preferences. Methods: Retrospective and prospective data were obtained to conduct a comparison observational study to assess the impact of introducing a supportive care register on the end-of-life care for patients with advanced CKD. An electronic supportive care register was implemented. This required a programme of multi-disciplinary staff education, collaborative working with Palliative Care to establish renal-specific protocols and dissemination activities. The impact of the intervention was assessed by analysing all deaths in two six-month periods where all those with an eGFR <15 ml/min/1.73 m² at the time of their death were included. Results: A total of 91 patients were included. Post-intervention, there was a 25.4% (95% CI: 6.5-44.3%, p = 0.008) improvement in patients having a documented discussion about end-of-life planning. There was also a 19.7% (95% CI: 4.0-35.5%, p = 0.01) improvement in establishing the place of death. All patients who expressed a preferred place of death died there. The intervention increased engagement with the wider MDT and led to significant improvements in access to specialist palliative care services. Conclusions: These results show that the interventions implemented to introduce a supportive care register resulted in meaningful improvements to the end-of-life care for patients in our region with advanced CKD.

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“…In the context of EOL care, the United States is coming up short when it comes to the “triple aim” (Berwick, Nolan, and Whittington 2008) of improving patient experience with care, maximizing population health, and controlling healthcare spending. Evidence suggests that many people do not receive EOL care commensurate with their preferences (Fischer et al 2013), and those with unknown preferred places of death are up to three times more likely to die in a hospital (Arnold, Finucane, and Oxenham 2015). Persistent racial-ethnic and socioeconomic health disparities exist in the EOL healthcare context (LoPresti, Dement, and Gold 2014; National Hospice and Palliative Care Organization [NHPCO] 2015), and costly patterns of utilization (e.g., multiple transitions across healthcare settings, hospice stays of less than three days, and accelerated use of acute and intensive care) are commonplace in the last 10 to 14 days of life (Teno et al 2013).…”

Section: Introductionmentioning

confidence: 99%

Transforming Patient Compliance Research in an Era of Biomedicalization

Spencer

2018

J Health Soc Behav

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The term patient noncompliance emerged in the 1970s as a tool for analyzing why people do not follow medical directives. Despite its early popularity, the term has languished in sociology while flourishing in biomedical arenas. It seems flaccid in a contemporary healthcare context as it overestimates physician authority and is tone-deaf to biomedicalization. I draw from sociological and anthropological traditions, as well as qualitative interviews with terminally ill patients ( N = 26) and their caregivers ( N = 16), to consider facets of a biomedicalized health experience and implications for an updated vision of compliance. First, pathways to care have proliferated under biomedicalization. With increased pathways comes increased need for understanding how treatment plans are socially constituted and assessed. Finally, increased complexity demands a more diverse vocabulary for understanding health related decisions. This paper is a call to sociologists to take the lead in transforming and updating this consequential concept.

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Preferred place of death for patients referred to a specialist palliative care service

Cited by 66 publications

References 12 publications

Preferred and actual place of death in haematological malignancy

Preferred and actual place of death in haematological malignancy

Establishing a Supportive Care Register Improves End-of-Life Care for Patients with Advanced Chronic Kidney Disease

Transforming Patient Compliance Research in an Era of Biomedicalization

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