The importance of identifying preferred place of death

Ali, Maimoona; Capel, Margred; Jones, Gareth Wyn; Gazi, Terri

doi:10.1136/bmjspcare-2015-000878

Cited by 88 publications

(71 citation statements)

References 24 publications

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“…10 The American Society for Clinical Oncology has also published guidelines recognising that palliative care services should be integrated into routine healthcare for patients with advanced cancer, though no specific recommendation was made regarding haematology. 9 Dying in a preferred place is generally considered a quality marker for good end-of-life care, 11 with preference for home death predominating. 12 However, current evidence suggests that many patients with haematological malignancies do not die in their preferred place.…”

Section: Original Researchmentioning

confidence: 99%

Preferred and actual place of death in haematological malignancies: a report from the UK haematological malignancy research network

Sheridan

Roman

Smith

et al. 2020

BMJ Support Palliat Care

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ObjectivesHospital death is comparatively common in people with haematological cancers, but little is known about patient preferences. This study investigated actual and preferred place of death, concurrence between these and characteristics of preferred place discussions.MethodsSet within a population-based haematological malignancy patient cohort, adults (≥18 years) diagnosed 2004–2012 who died 2011–2012 were included (n=963). Data were obtained via routine linkages (date, place and cause of death) and abstraction of hospital records (diagnosis, demographics, preferred place discussions). Logistic regression investigated associations between patient and clinical factors and place of death, and factors associated with the likelihood of having a preferred place discussion.ResultsOf 892 patients (92.6%) alive 2 weeks after diagnosis, 58.0% subsequently died in hospital (home, 20.0%; care home, 11.9%; hospice, 10.2%). A preferred place discussion was documented for 453 patients (50.8%). Discussions were more likely in women (p=0.003), those referred to specialist palliative care (p<0.001), and where cause of death was haematological cancer (p<0.001); and less likely in those living in deprived areas (p=0.005). Patients with a discussion were significantly (p<0.05) less likely to die in hospital. Last recorded preferences were: home (40.6%), hospice (18.1%), hospital (17.7%) and care home (14.1%); two-thirds died in their final preferred place. Multiple discussions occurred for 58.3% of the 453, with preferences varying by proximity to death and participants in the discussion.ConclusionChallenges remain in ensuring that patients are supported to have meaningful end-of-life discussions, with healthcare services that are able to respond to changing decisions over time.

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Section: Original Researchmentioning

confidence: 99%

Preferred and actual place of death in haematological malignancies: a report from the UK haematological malignancy research network

Sheridan

Roman

Smith

et al. 2020

BMJ Support Palliat Care

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“…[17] Tier 1 includes peoples' preferences for end-of-life care; choosing a place of death helps people to die at home, whereas people whose preference is unknown are more likely to be admitted to hospital for end-of-life care. [18] The proportion of Asian participants in this study expressing a preferred place of death or signing a Do Not Recuscitate Agreement was low compared with other studies; [19] this highlights an unmet need for advocacy to better prepare elderly Taiwanese people for death. The prevalence of frailty was similar to other reports.…”

Section: Discussionmentioning

confidence: 58%

First Insights on Value-Based Healthcare of Elders Using ICHOM Older Person Standard Set Reporting

Lee

Peng

Lin

et al. 2020

Preprint

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Background: Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset.Methods: The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0–10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points. Results: Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease burden (OR 0.40, 95% CI 0.21–0.76, p=0.005) or cognitive impairment (OR 0.49, 95%CI 0.27–0.87, p=0.014) were less likely to have high value-based healthcare status. Conclusions: The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to whole person-focused goals. This study identified advanced age, chronic disease burden and cognitive impairment as important barriers to achieving high value-based healthcare status.

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“…[14] Tier 1 includes peoples' preferences for end-of-life care; choosing a place of death helps people to die at home, whereas people whose preference is unknown are more likely to be admitted to hospital for end-of-life care. [15] Lower proportions of the Asian participants in this study compared with westerners had expressed a preferred place of death or signed Do Not Resuscitate agreements, [16] which highlights an unmet need for advocacy to better prepare elderly Taiwanese people for death. The prevalence of frailty was similar to other reports.…”

Section: Discussionmentioning

confidence: 79%

First Insights on Value-Based Healthcare of Elders Using ICHOM Older Person Standard Set Reporting

Lee

Peng

Lin

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset. Methods: The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions who received value-based healthcare services between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0–10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points. Results: Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease severity (OR 0.40, 95% CI 0.21–0.76, p=0.005) or cognitive impairment (OR 0.49, 95%CI 0.27–0.87, p=0.014) were less likely to have high value-based healthcare status. Conclusions: The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to patient-focused goals. This study identified advanced age, chronic disease and cognitive impairment as important barriers to achieving high value-based healthcare status.

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The importance of identifying preferred place of death

Cited by 88 publications

References 24 publications

Preferred and actual place of death in haematological malignancies: a report from the UK haematological malignancy research network

Preferred and actual place of death in haematological malignancies: a report from the UK haematological malignancy research network

First Insights on Value-Based Healthcare of Elders Using ICHOM Older Person Standard Set Reporting

First Insights on Value-Based Healthcare of Elders Using ICHOM Older Person Standard Set Reporting

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