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Place of care: from referral to specialist palliative care until death
  1. Mary Jane O'Leary1,2,
  2. Alison C O'Brien3,
  3. Marie Murphy1,4,
  4. Claire M Crowley5,
  5. Helen M Leahy6,
  6. Jill M McCarthy6,
  7. Joan C Collins7 and
  8. Tony O'Brien1,7
  1. 1Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
  2. 2Hospice Palliative & End of Life Care, Fraser Health Authority, British Columbia, Canada
  3. 3Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
  4. 4Palliative Medicine, Mercy University Hospital, Cork, Ireland
  5. 5Palliative Medicine, Bon Secours Hospital, Cork, Ireland
  6. 6Palliative Medicine, South Infirmary-Victoria University Hospital, Cork, Ireland
  7. 7Palliative Medicine, Cork University Hospital, Cork, Ireland
  1. Correspondence to Dr Mary Jane O'Leary; maryjaneol{at}


Background While there are many poorly standardised studies focusing on place of death, there are limited data on place(s) of care during the final stages of disease.

Aim This study aims to identify where patients are cared for in the interval from referral to specialist palliative care until death.

Methods All patients who died while under the care of a specialist palliative care service over a 6-month period were considered.

Results Of the 507 patients included, 255 (50.3%) were men and 428 (84.4%) had a malignant diagnosis. The mean referral-to-death interval was 70 days (SD 113, Range 1–838). The majority (n=281, 55.4%) received care in a single care setting—hospital (28.4%), home (21.5%), nursing home/community hospital (4.1%), hospice (1.4%)—and had a shorter mean referral-to-death interval. Most patients with more than one care setting spent three-quarters of their time in their normal place of residence. A total of 199 (39.3%) died in hospital, 131 (25.8%) in hospice, 131 (25.8%) at home (25.8%) and 46 (9.1%) in a nursing home/community hospital. Patients referred by a general practitioner (n=80 patients, 15.8%) were more likely to be cared for at home (p<0.001), and die at home (p<0.001).

Conclusions A significant number of patients received specialist palliative care across multiple care settings. Late referral is associated with a single domain of care. General practitioner involvement supports patient care and death at home. Place of care and ease of transfer between care settings may be better indicators of the quality of care we provide.

  • Communication
  • Home care
  • Hospice care
  • Hospital care
  • Nursing Home care

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.