Barriers and facilitators to achieving home death

The aim of this study is to explore the barriers and facilitators to patients achieving death at home | BMJ Supportive & Palliative Care

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Methods: In-depth, semistructured interviews with end-of-life care experts were conducted to develop an insight into the barriers and facilitators to achieving death at home. Thirty-three interviews were conducted compromising of a mixture of face-to-face and tele interviews. Experts included healthcare professionals working in the community, hospital and policy/academic settings. Thematic analysis was undertaken on interview transcripts.

Results: Three overarching themes, further divided into a total of 12 subthemes were identified. The three themes were ‘managing people’, ‘education’ and ‘planning’. The ‘managing people’ theme included subthemes of patient preferences and family influences; the ‘education’ theme encompassed knowledge and training, perceptions of death and communication and the ‘planning’ theme contained seven subthemes including ‘coordination’, ‘resources’ and ‘cost’.

Conclusions: Multiple barriers and facilitators to achieving death at home were identified in this study. Of particular significance was the identification of the fear and stigma associated with death among doctors, patients and their families serving as a barrier to home death, not previously identified in the literature. Additionally, the importance of social networks and resource provision were highlighted as key in influencing patient death at home.

Full reference: Sayma, M. et al. (2017) A qualitative inquiry into the barriers and facilitators to achieving home death. BMJ Supportive & Palliative Care. Published Online First: 31 July 2017.

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End of life strategy probably improved choice of where to die for people with severe respiratory disease

Most people prefer not to die in hospital, but the majority of patients with long-term diseases other than cancer end up dying there | NIHR Signal

In England, an NIHR study based on routine collected national data showed that roll-out of the End of Life Care strategy in 2004 was linked to a reduction in deaths in hospital. The number of deaths here fell by 6% for people with chronic obstructive pulmonary disease (COPD), and 3% for people with interstitial lung diseases. However, hospital deaths did not fall for respiratory patients with other conditions, like heart failure.

The strategy aimed to allow people to die where they chose. It prioritised home care over hospital care, and addressing the needs and preferences of patients and carers.

The fall in the number of hospital deaths is probably the result of the strategy. The results are similar to those observed in cancer care, and the reduction in hospital deaths clearly emerged after the strategy was introduced, and increased after an intensified roll-out in 2008.

To improve impact, early and integrated palliative care approaches are needed, targeting those at highest risk. Particular focus should be on patients with comorbidities and people living in more deprived areas, where place of death has remained unchanged.

Fear of talking about dying ‘leading to thousands of traumatic hospital deaths’

Cancer charity says there is a ‘crisis of communication’ in UK over dying | The Independent

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Thousands of cancer patients would prefer to die at home but are forced to suffer “traumatic” deaths in hospital, according to Macmillan. Taboos around talking about death are fuelling a “crisis of communication” in the UK that prevents people from planning their final days, warned the organisation in a new report.

Research by the charity found that while 38 per cent of people who die from cancer die in hospital, just one per cent would choose to do so, with 64 per cent saying they wanted to die at home.

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Home palliative care works: but how?

Sarmento, V.P. et al. BMJ Supportive & Palliative Care. Published Online: 23 February 2017

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Objective: To understand patients and family caregivers’ experiences with home palliative care services, in order to identify, explore and integrate the key components of care that shape the experiences of service users.

Conclusions: Home palliative care teams improve patients and caregivers experience of security when facing life-limiting illnesses at home, by providing competent care and being present. These teams should therefore be widely available and empowered with the resources to be present and provide competent care.

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Transferring patients home to die: what is the potential population in UK critical care units?

Coombs M.A. et al. (2017) BMJ Supportive & Palliative Care. 7:98-101

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Objectives: Most people when asked, express a preference to die at home, but little is known about whether this is an option for critically ill patients. A retrospective cohort study was undertaken to describe the size and characteristics of the critical care population who could potentially be transferred home to die if they expressed such a wish.

Conclusions: A little over 20% of patients dying in critical care demonstrate potential to be transferred home to die. Staff should actively consider the practice of transferring home as an option for care at end of life for these patients.

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Dying at home of cancer: whose needs are being met?

Pottle, J. et al. BMJ Supportive & Palliative Care. Published online: 16 January

clasped-hands-541849_960_720Objectives: Supporting patients to die in the place of their choosing is an important aspect of end of life care. Our study set out to answer the question: ‘How does the home environment influence perceptions of quality of death, and the experience of caring for the dying at home, for family carers and healthcare professionals (HCPs)?

Conclusions: We have shed light on the complexity of balancing the demands and the satisfaction of caring for someone dying at home. The ability to manage these conflicting needs influenced whether carers perceived the home setting as the best place for the person to have received care in their last days of life.

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What determines duration of palliative care before death for patients with advanced disease?

Bennet, M.L. et al. (2016) BMJ Open. 6:e012576

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Objective For patients with advanced cancer, several randomised controlled trials have shown that access to palliative care at least 6 months before death can improve symptoms, reduce unplanned hospital admissions, minimise aggressive cancer treatments and enable patients to make choices about their end-of-life care, including exercising the choice to die at home. This study determines in a UK population the duration of palliative care before death and explores influencing factors.

Conclusions The current timing of referral to palliative care may limit the benefits to patients in terms of improvements in end-of-life care, particularly for older patients and patients with conditions other than cancer.

Read the full abstract and article here