eLetters

16 e-Letters

published between 2016 and 2019

  • Preferred Place of Death: Time for a Rebirth

    In McCaughan’s qualitative study,(1) I was drawn by two themes identified from interviews with clinicians and relatives of patients with haematological cancers: ‘mismatch between the expectations and reality of home death’ and ‘a preference for hospital death.’ This challenges the established dogma that most people would wish to die at home, if they had the choice.(2)

    The paper goes on to posit reasons, namely that patients with haematological cancers can have complicated clinical trajectories, with difficult-to-manage symptoms towards the end of life. Whilst this is true, it can also be more broadly applied to many terminal disease trajectories, in which single organ failure can progress to multi-organ involvement, brittle health and the risk of sudden deterioration. This can be frightening for both the patient and their close ones, hence an emergency call and blue light to A&E. Inpatient symptom control and support may then ineluctably become inpatient terminal care.

    In fact, desire for a home death is likely an overstated assertion, particularly as people approach the terminal phase of illness,(3) and particularly in conditions other than cancer.(4) The ideal of a home death may be very different to the reality of managing complex symptoms without the 24-hour access to medical professionals or support available in a hospital or hospice.

    The National End of Life Care Intelligence Network identifies death in the ‘usual place of residence’ (home...

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  • EPaCCS and the need for research
    Matthew J Allsop

    We agree with Sleeman and Higginson [1] who emphasised the need to gather evidence of effectiveness of EPaCCS before widespread and uncritical adoption by the NHS. An EPaCCS evaluation framework was recently developed by our team on behalf of end of life commissioners in Leeds [2]. There was, and remains, a scarcity of guidance on approaches to gathering evidence for EPaCCS but we identified factors that highlight the c...

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  • Warning - EPaCCS may NOT facilitate home deaths
    Lesley Wye

    As the lead of a Marie Curie funded study of EPaCCS, I welcome the attention that electronic palliative care systems are increasingly receiving. However unlike Petrova et al, I believe the "striking" EPaCCS results on facilitating home deaths mentioned by Petrova et al may largely be explained by selection bias.

    In our mixed methods study, we too found impressive results in that those with an electronic EPaCCS...

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  • Are mental disorders still a significant factor in denying or granting requests for hastened death?
    Keith M. Swetz
    Wilson and colleagues are to be commended for their excellent work in exploring mental illnesses and desire for death in patients receiving palliative care with malignancy. [1] The piece thoughtfully explores the prevalence of depression, anxiety and mood disorders and the association between these diagnoses and a standardized quantification of the patient's desire for death. In all, the authors found that 30.5% of participants e...
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  • Evidence based policy in palliative care - time to learn from our mistakes
    Katherine E. Sleeman

    The article by Petrova et al is timely and thought provoking.1 EPaCCS (Electronic Palliative Care Coordination Systems) have good face value: they appear so obviously a good idea. But scratch beneath the surface, as Petrova and colleagues have done, and important challenges in public perceptions, funding, information governance, context and health care IT become apparent.

    EPaCCS are electronic information system...

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  • Canadian Palliative Care Physicians Concerned about Assisted Suicide too.
    Susan M MacDonald

    British and European palliative care physicians are not alone in their concerns and reluctance to participate in Physician Assisted Suicide/Euthanasia. Canadian Palliative care physicians struggle with this issue as well. In 2010, the Canadian Society of Palliative Care physicians (300 members) were surveyed. (1) The questions were specific: "Are you for or against PAS/Euthanasia?" "Would you provide assisted suicide?" "W...

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