Improved end of life care planning allows more patients to die at home, finds study

When asked, just 1% of patients in the study said they wanted to die in hospital.

Matt Bodell
10 December 2020
EOLC

Without a place of death preference recorded patients were much more likely to die in hospital.

Having open and honest discussions about patients about end of life care preferences would allow more patients to die at home, according to a new study.

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Researchers at The Royal Marsden NHS Foundation Trust and Imperial College London analysed the advanced care records of 21,231 patients in the UK.

Using the UK’s largest electronic palliative care register, Coordinate My Care, they analysed the anonymised recorded care preferences and place of death outcomes for 21,231 adults on this register who died between March 2011 and July 2019.

The researchers found that of the 16,593 individuals where both preferred place of death and actual place of death was recorded, 56 percent (9,328) preferred to die at home, while just 1 percent (210 individuals) wished to die in hospital.

Across the whole cohort, which included individuals without a recorded place of death preference, 22 percent of individuals (4,626) died in hospital, with 78 percent dying in non-hospital settings, including at home (7,709, 36 percent) or in a care home (5,645, 27 percent).

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The researchers note that patients without a recorded place of death preference were much more likely to die in hospital than those with a recorded preference.

Although not all patients in this cohort were able to die in their place of choice, the authors conclude that advance care planning could help influence individuals’ end-of-life care experiences by facilitating patients, their families and clinicians to engage in discussions about their preferences for care.

Advance care planning gives patients the opportunity to discuss, express and document their wishes and preferences about future medical treatment and end-of-life care.

The authors added: “Advance care planning should be included in routine clinical care. Electronic palliative care registers, such as Coordinate My Care, have the capacity to improve end-of-life care as they enable patients and clinicians to record and make advance care decisions, before sharing them in real time with relevant healthcare professionals.”

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