The Right Place at the Right Time: Medical Oncology Outpatients' Perceptions of Location of End-of-Life Care

Abstract

Background: Helping people achieve their preferred location of care is an important indicator of quality end-of-life (EOL) care. Using a sample of Australian medical oncology outpatients, this study examined (1) their preferred location of EOL care; (2) their perceived benefits and worries of receiving care in that location; (3) the percentage who had discussed preferences with their doctor and/or support person; and (4) whether they wanted their doctor to ask them where they wanted to die. Methods: Adults with a confirmed diagnosis of cancer were approached between September 2015 and January 2016 in the waiting room of an Australian oncology outpatient clinic. Consenting participants completed a home-based pen-and-paper survey indicating preferred location of care, perceived benefits and worries of that location, whether they had discussed preferences with their doctors, and whether they were willing to be asked about their preferences. Results: A total of 203 patients returned the survey (47% of those eligible). Less than half preferred to be cared for at home (47%), 34% preferred a hospice/palliative care unit, and 19% preferred the hospital. Common benefits and worries associated with locations included perceived burden on others, familiarity of environment, availability of expert medical care, symptom management, and likelihood of having wishes respected. More patients had discussed preferences with their support persons (41%) than doctors (7%). Most wanted a doctor to ask them about preferred location of care (87%) and thought it was important to die in the location of their choice (93%). Conclusions: Patients were willing to have clinicians to ask them where they wanted to die, although few had discussed their preferences with doctors. Although home was the most preferred location for many patients, the overall variation suggests that clinicians should adopt a systematic approach to eliciting patient preferences. J Natl Compr Canc Netw 2018;16(1):35-41 doi: 10.6004/jnccn.2017.7025 Research into location of end-of-life (EOL) care offers insight into whether people are accessing resources that aim to improve quality of dying and support appropriate service planning. 1 A recent population-level study of patients with cancer in 14 countries reported that between 12% and 57% of patients die at home and between 22%

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Decision-Making Process for the Place of Death of Elderly Patients with Advanced Cancer and Their Families

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“…A description of the study sample and procedures was published previously. 22,23 Briefly, clinic staff identified eligible participants, which included adult medical oncology outpatients attending their second or subsequent appointment at a tertiary treatment center, who were able to read and understand English, and who were judged as being physically and cognitively able to participate. Patients who indicated to clinic staff that they would be willing to talk to a trained research assistant were approached for consent to complete a pen-and-paper survey.…”

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