A patient’s preferred place of death (PPD) is frequently used as a marker for quality of end of life care. However, surveys of patients with life-limiting conditions indicate that “dying in preferred place” is not their highest priority (Actions for End of Life Care NHSE 2014-2016). As end of life approaches other priorities often take precedence and PPD may change.
Aim of our audit To establish how many inpatients referred to our hospital Supportive and Palliative Care Team (SPCT) had PPD recorded, what their preferences were and whether they changed.
Methods Data was extracted retrospectively from a database of inpatient deaths referred to the SPCT between July and August 2016
Results 63 patients had a PPD recorded - 33 patients at initial consultation and 30 patients at subsequent consultation. Initial PPD was acute hospital (25), home (16), no preference (9), hospice (9), care home (4).13 patients (21%) changed their PPD during their admission. 6 patients with initial PPD home or hospice changed to acute hospital. 4 people changed their preference to care home (from hospice or home). From 16 patients whose initial PPD was home, this remained their final preference in 7 cases. 6 patients changed their PPD more than once.
Conclusions Our data shows that almost half of patients do not discuss PPD at initial consultation but are happy to state preferences subsequently. This could be due to development of rapport and relationship with SPCT members. Interestingly, PPD changed during the hospital admission in one fifth of cases with the majority electing to not spend last days of life at home. This could be due to changes in condition, symptoms and performance status coupled with perceived burden on caregivers. Discussing preferences for place of death should be a dynamic process as care related priorities may change as end of life approaches.
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