Objectives To explore the barriers and facilitators to patients achieving death at home.
Methods In-depth, semistructured interviews with end-of-life care experts were conducted to develop an insight into the barriers and facilitators to achieving death at home. Thirty-three interviews were conducted compromising of a mixture of face-to-face and tele interviews. Experts included healthcare professionals working in the community, hospital and policy/academic settings. Thematic analysis was undertaken on interview transcripts.
Results Three overarching themes, further divided into a total of 12 subthemes were identified. The three themes were ‘managing people’, ‘education' and ‘planning’. The ‘managing people’ theme included subthemes of patient preferences and family influences; the ‘education’ theme encompassed knowledge and training, perceptions of death and communication and the ‘planning’ theme contained seven subthemes including ‘coordination’, ‘resources’ and ‘cost’.
Conclusions Multiple barriers and facilitators to achieving death at home were identified in this study. Of particular significance was the identification of the fear and stigma associated with death among doctors, patients and their families serving as a barrier to home death, not previously identified in the literature. Additionally, the importance of social networks and resource provision were highlighted as key in influencing patient death at home.
- home death
- Received 14 October 2016.
- Revision received 22 May 2017.
- Accepted 26 June 2017.
- © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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Contributors All authors were responsible for the planning and design of the study.MS, DS, ASW, SJ, AA, DK and FO were responsible for collecting data.AA and DK were responsible for data analysis.All authors were responsible for writing-up and approving the study.MS was responsible for final submission and as guarantor of content.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Ethics approval Imperial College Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Some findings from this paper were presented at the Marie Curie Annual Research Conference, 2016. International Congress on Palliative Care and King's Fund innovations in EoLC.
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