Aim To review whether a cohort of patients referred to the Countess Mountbatten Palliative Care service achieved their preferred place of death (PPD).
Method A clinical notes review of the first 100 patients referred to the service from 1st June 2017 specifically looking at preferred place of death, actual place of death and, if relevant, reasons PPD wasn’t achieved. Length of time known to service and likelihood of achieving PPD were also studied.
Results Of the 100 patients studied 35 had PPD of Home, 25 had PPD of Hospice, three had PPD of acute hospital, 27 PPD remained unknown and 10 had no preference.
PPD of Home was achieved in 17 of the 35 patients (49%). PPD of Hospice was achieved in 22 of the 25 patients (88%) and PPD of acute Hospital was achieved in all three patients (100%). Patients known to the service between 2 to 12 weeks were the most likely to achieve their PPD (64%).
Discussion Lack of care and equipment at home, carer distress and difficult symptom control were the main reasons for not achieving PPD of Home. Reasons for not achieving PPD of Hospice included rapid deterioration making patient transfer inappropriate. Where PPD was unknown, most patients were only known to the service for a short period before death and the majority of patients were acutely unwell and PPD discussion was felt to be inappropriate.
Conclusions Rapid access to care and equipment in the home could result in more patients achieving their PPD. Increased community support and a hospice at home service could potentially provide this.
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