Home not always best or preferred place to die, says end-of-life expert

By The Press Association7th October 2015News EnglandEnd Of Life Care, News England, Older People

Home is not always the best or preferred place to die, an expert has said.

Kristian Pollock, from the University of Nottingham, said evidence suggesting most people would prefer to die at home is not as strong as previously thought.

Writing in the British Medical Journal (BMJ), she said: “Focusing on place of death as the key indicator of quality in end-of-life care distracts attention from the experience of dying.”

She called for “more attention and resources to be spent on improving end-of-life care wherever this occurs, in hospitals or elsewhere”.

Dr Pollock said most people fear dying in pain and evidence suggests pain is less well controlled at home.

Idealised accounts of “the good death” at home often do not recognise the reality of the pain and discomfort experienced by some dying patients, she said.

She argued that some patients may prefer to be in hospital because they view it as a place of safety, where symptoms can be controlled.

Others may not wish to be a burden on their family.

Dr Pollock said: “When patients wish to die at home, every effort should be made to achieve this outcome.

“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 realised.”

Professor Julia Verne, end-of-life clinical lead at Public Health England, welcomed the study.

She said patients wanted their pain and other symptoms managed effectively, and wanted to be surrounded by loved ones and to be treated with dignity.

“While evidence shows that home continues to be the preferred place of death for people in England, it’s important to note that preferences can change over time,” she said.

“Around half of all deaths in England occur in hospital, so it’s important that hospitals have resources in place to deliver high-quality care for patients in their final days of life.

“It is key that we continue to focus our attention on improving end-of-life care and the experience of dying, wherever it may be.”

Lynda Thomas, chief executive of Macmillan Cancer Support, said: “There should always be an emphasis on enabling high quality care and personal choice at the end of life, whatever the setting.

“Sadly we know that not everybody who wishes to die at home is able to do so because of a lack of support, meaning that people end up in hospital against their wishes.

“Similarly, for people who would prefer to die in hospitals, it is equally vital they also have access to the right care.”