Where do patients known to a community palliative care service die?

Abstract

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.

Congruence between preferred and actual place of death according to the presence of malignant or non-malignant disease: a systematic review and meta-analysis

“…Only four studies provided comparative data for a cancer and non-cancer cohort with two studies focusing on congruence specifically for separate cancer and non-cancer cohorts13 33 and the remaining studies examining preferences as a factor associated with place of death 8 15. Seventeen studies provided non-comparative data for cancer patients only,9–12 14 16 18–20 23 25 26 28–32 while five studies analysed congruence for non-cancer patients exclusively 17 21 22 24 27…”

“…Eleven studies were graded B level because of retrospective design, single-service populations, or response rates less than 80% 8 9 11 13 14 17 19 22 26 27 30. Eleven studies were also graded C level because of response rates less than 60% or inconsistent assessment of preferences 10 12 15 16 18 20 21 23–25 32…”

End-of-life care—what do cancer patients want?

“…Providing palliative care at an early stage of the patient's illness is effective, and integration of palliative care with oncology services is vital to enable this to occur. Advance care planning is a cornerstone of effective endoflife care for patients with cancer, 45,68 and falls within the remit of oncologists, community services and specialist palliative care teams. The precise roles and responsibilities of oncology services in relation to end oflife care for patients with advanced cancer, includ ing the overlap with palliative care services, is an area that would benefit from further qualitative exploration.…”

“…27 The impact of advance care planning on place of death is further emphasized by the results from a study that analysed the location of death of 788 patients with advanced illness-including cancer-who were already under the care of a commu nity palliative care team. 68 Of the patients who had declined to express a preference regarding their place of death during their illness, 54% subsequently died in hospital, despite being under the care of a community palliative care team.…”

The emotional impact of nursing : identifying issues and supporting staff

“…Most terminally ill people would prefer to die in their own home (Eyre, 2010;Stevens, Spencer-Grey, Heller & Komaromy, 2009), however only about a quarter of these people do so. This has been found to be due to a range of factors including the quality of family support, and the availability of social and healthcare support, including home based palliative care (Capel, Gazi, Vout, Wilson & Finley, 2012;Sheppard, Wee & Straus, 2011,).…”