Background Achievement of ‘preferred place of death’ (PPD) has been adopted as a key performance indicator for quality in end of life care. Approximately 60%–70% of people report they wish to die at home, however, evidence shows that place of death is actually only 7th on the list of priorities for ‘a good death’. The aim of this audit was to evaluate the proportion of patients who achieved their PPD; and if not, why this was not attainable. It also assessed if diagnosis made an impact on the achievement of PPD.
Methods Retrospective case note review of the last 50 cancer and 50 non-cancer deaths prior to 1 st October 2015 where a PPD was documented in the hospice electronic record. Information regarding the events and care prior to death was sourced from hospice, GP, hospital and district nursing records.
Results 67/100 (67%) of patients stated home as their PPD. 35/50 (70%) cancer and 40/50 (80%) non-cancer patients achieved their PPD. Of the 25 patients who did not achieve their PPD, there were 3 categories of reasons for this:
Unforeseen circumstances (68%) e.g. uncontrolled care or symptom needs, rapid deterioration preventing transfer, ongoing active treatment;
System limitations (24%) e.g. bed or care package unavailability;
Missed opportunities for implementation of anticipatory measures (8%) e.g. no ‘just in case’ box, poor communication between care settings.
Conclusions 3 out of 4 patients achieved their PPD. Diagnosis did not appear to significantly impact whether PPD was achieved. Where PPD was not achieved, unforeseen circumstances was the most common reason.
Discussions about PPD should include exploration of unforeseen circumstances.
Patients‘ overall priorities for care should be identified in conjunction with PPD discussions.
PPD achievement should be avoided as a marker of quality care.
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