End-Of-Life Care: Home May Not Be The Best Or Preferred Place To Die After All
Given the opportunity, most people choose a comfortable setting to die in, like their house. In fact, the United Kingdom’s government considers place of death to be a key indicator for quality of end of life care. Now a report written by Principal Research Fellow at the University of Nottingham Kristin Pollock suggests that a patient’s home may not be “the best and preferred place of death.”
“When patients wish to die at home, every effort should be made to achieve this outcome,” Pollock said in a statement. “However, until resources are in place to adequately and equitably support home deaths, the current promotion of patient choice risks raising expectations that are not realized.”
Due to poor quality of care and high costs, hospitals are often considered inappropriate and undesirable places to die. However, many patients, especially those suffering from distress and pain, prefer hospitals for the perceived safety it provides and effective control of symptoms. Other patients prefer transferring their care from home to hospital in order to avoid burdening their family.
Pollock said that accounts of the so-called “good death” at home do not account for the pain and discomfort they experience. "The person may have been alone, inadequately supported, in pain, distressed, and fearful," she explained. Research shows that dying in pain is a much bigger concern for most patients compared to place of death.
She added that "focusing on place of death as the key indicator of quality in end of life care distracts attention from the experience of dying." She also urges "more attention and resources to be spent on improving end of life care wherever this occurs, in hospitals or elsewhere." However, she does believe in accommodating a patient’s preferred place of death.
Since hospitals tend to be the common place of death regardless of the patient’s preferences, she said that instead of "neglecting and disregarding the hospital as a site of terminal care, much greater thought and adequate resources must be directed to enabling hospitals to provide excellent support for dying patients and their families."
A recent survey conducted by the Centers for Disease Control and Prevention shows that most Americans would rather die at home these days and that most families are honoring their loved one’s wish. In 2010, hospital deaths accounted for 29 percent of all U.S. deaths, which was up from 32 percent in 2000. Since then, the number of hospital deaths has continued to decline.
Source: Pollock K. Analysis: Is home always the best and preferred place of death? The BMJ. 2015.