Background ‘There is currently a significant gap between preferred and actual place of death, with over half not dying where they would choose, too many dying in hospital and too few in their own home, care home or hospice’ Gold Standards Framework.

Aim To perform a network-wide audit of the Preferred Place of Death (PPD) of patients known to SPC to ascertain whether their wishes were fulfilled. Method: Data was collected from SPC clinicians regarding last expressed PPD, actual place of death, and reasons for discrepancy for all patients known to SPC teams (communities, hospices, hospitals) across the Mount Vernon Cancer Network. The study period was 3 months.

Outcomes 708 consecutive patients were included – 320 (45%) died in hospital, 179 (25%) at home, 172 (25%) in hospice, 28 (4%) in care home and 9 (1%) unknown. (a) Outcomes where PPD known: 426 (60%) had a PPD which were 184 (43%) home, 159 (37%) hospice, 53 (13%) hospital, 30 (7%) care home. 349 (82%) achieved their wishes. 77 (18%) died elsewhere due to unexpected deterioration (34), physical condition (14), continuing healthcare delays (13), lack of family agreement (6), no available bed (3), unknown (7). A patient was 5.5 times more likely to die at home. (b) Outcomes where PPD unknown: 282(40%) had unknown PPD. 215(76%) died in hospital, 35(12%) hospice, 18(6%) home, 10(4%) care home, 4(1%) unknown. A patient was 3 times more likely to die in hospital.

Conclusion 82% of patients with known PPD achieved their wishes. Physical symptoms and unexpected deterioration were the primary reasons cited for those dying elsewhere. 40% of patients had no known PPD and of these 76% died in hospital. Extension of discussion and documentation of PPD to more patients would increase patient choice and is likely to reduce numbers of patients dying in hospital, and increase deaths at home across this population.