Preferred place of care at the end of life for people in hospitals

Abstract

Background: Achievement of a person’s preferences for end-of-life care is a moral and policy imperative. It is morally important, as it demonstrates respect for people’s end-of-life choices and a policy imperative because it is recognised that many people who die do not die in the place of their choice. Much has been written about the factors influencing preferred place of care (PPC) and where people die. Little attention has been paid to which interventions enhance achievement of PPC. Aim: This article reports the findings of an audit, the aim of which was to assess the impact of the interventions of hospital discharge team nurses (HDTNs) on the achievement of PPC. Methods: The audit was undertaken of a consecutive sample of 39 people referred at the end of life to the HDTNs, over a 3-month period, from May to July 2009. The data were analysed using Cohen’s Kappa statistic to test the degree to which PPC was achieved. Results: All but three people achieved their PPC. The audit demonstrated that coordination and support from HDTNs is an effective intervention in managing and achieving PPC. Conclusions: The results compare very favourably with studies assessing success in achieving preferred and actual place of end-of-life care. Key to the success of this intervention was the HDTNs’ knowledge of community services, imparted during conversations with patients and their families. Conflicts of interest: none