Abstract
BackgroundHome death is one of the key performance indicators of the quality of palliative care service delivery. Such a measure has direct implications on everyone involved at the end of life of a dying patient, including a patient’s carers and healthcare professionals. There are no studies that focus on the views of the team of integrated inpatient and community palliative care service staff on the issue of preference of place of death of their patients. This study addresses that gap.MethodsThirty-eight participants from five disciplines in two South Australian (SA) public hospitals working within a multidisciplinary inpatient and community integrated specialist palliative care service, participated in audio-recorded focus groups and one-on-one interviews. Data were transcribed and thematically analysed.ResultsTwo major and five minor themes were identified. The first theme focused on the role of healthcare professionals in decisions regarding place of death, and consisted of two minor themes, that healthcare professionals act to: a) mediate conversations between patient and carer; and b) adjust expectations and facilitate informed choice. The second theme, healthcare professionals’ perspectives on the preference of place of death, comprised three minor themes, identifying: a) the characteristics of the preferred place of death; b) home as a romanticised place of death; and c) the implications of idealising home death.ConclusionHealthcare professionals support and actively influence the decision-making of patients and family regarding preference of place of death whilst acting to protect the relationship between the patient and their family/carer. Further, according to healthcare professionals, home is neither always the most preferred nor the ideal place for death. Therefore, branding home death as the ideal and hospital death as a failure sets up families/carers to feel guilty if a home death is not achieved and undermines the need for and appropriateness of death in institutionalised settings.
Highlights
Home death is one of the key performance indicators of the quality of palliative care service delivery
Two major themes were identified from the data: Theme 1: The Role of healthcare professionals in decisions regarding place of death is comprised of two sub-themes: to a) mediate conversations and protect relationships between the patient and their carers; and b) adjust expectations and facilitate informed choice
The study found that Healthcare professionals (HP) reported acting to influence decisions about place of death of patients, identified that the nomination of a home as the preferred place of death often rests on a romanticised notion of death and, when patients and families are faced with the real emotional and practical demands and care needs associated with death and dying, death in an institutionalised setting is often preferred
Summary
Home death is one of the key performance indicators of the quality of palliative care service delivery. Such a measure has direct implications on everyone involved at the end of life of a dying patient, including a patient’s carers and healthcare professionals. There are no studies that focus on the views of the team of integrated inpatient and community palliative care service staff on the issue of preference of place of death of their patients. A commonly-cited South Australian (SA) 2006 study surveying 2652 participants across the general population reported that 70% expressed a preference to die at home if dying of a terminal illness [9]. The findings of such studies may not be representative of the views of patients suffering from other terminal illnesses, as highly person-centred factors influence preferences for place of death [10]
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