People Should Be Helped To Die At Home, Say Experts

Main Category: Palliative Care / Hospice Care
Also Included In: Public Health
Article Date: 03 May 2007 - 12:00 PDT

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Patients nearing the end of their lives who choose to die at home should have their preferences respected. In a paper published in the May issue of the Journal of the Royal Society of Medicine, leading palliative care experts (1,2,3) argue that although most people say that they would prefer to die at home, there has been a fall in people dying in their own homes. This is despite the rise in community palliative care services in the UK over the last 20 years.

"The reasons for this are complex, involving many aspects of healthcare practice and provision, as well as social changes," say the experts in palliative care.

The recent White Paper, Building on the best: choice, responsiveness and equity in the NHS, proposed that all adults nearing the end of their lives, regardless of diagnosis, should have the same access to high quality palliative care so that they can choose to die at home if they wish.

"For choice to be meaningful it must involve at least two, and preferably a range of, available, high quality options. However, many healthcare professionals feel it particularly difficult to discuss with a patient where they wish to die when providing adequate community services or securing admission to a hospice may not be possible" say the authors.

"Preferred place of death may be a hollow concept and promise of choice a cruel sham if services are not available because of lack of funding or other resources. Whilst simplistic rhetoric promising patients a planned death is seductive, the reality may be that the complex, uncontrollable nature of the dying process exposes real choice as being fool's gold".

There have been suggestions that better training in palliative care is needed for healthcare professionals, including those that work in primary care. However, there is very little evidence to inform how this should best be done. The paper calls for research to be carried out to investigate the experiences of healthcare professionals in managing what is a difficult and sensitive task.

"Exploring preferences is one part of an ongoing process of support which should be offered by the healthcare professionals who the patient knows and trusts, such as their own GP and district nurse" says Dr Munday. He continues: "A patient's preference for place of death may not always be clearly formulated and may change as their condition progresses; moreover, it may not be an issue they want to address. Healthcare professionals involved in this work therefore need to have good communication skills and must be prepared to invest time and effort in supporting dying patients, taking care to respect the patient's wishes."

(1) Daniel Munday, Macmillan Consultant/Honorary Clinical Senior Lecturer, Centre for Primary Health Care Studies, Warwick Medical School

(2) Jeremy Dale, Professor of Primary Care, Centre for Primary Health Care Studies, Warwick Medical School

(3) Scott Murray, St Columba's Hospice Professor of Primary Palliative Care, Division of Community Health Services, Edinburgh

'Choice and Place of Death: individual preferences, uncertainty and the availability of care' is published in the May issue (Vol. 100) of the Journal of the Royal Society of Medicine.

JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.

http://www.jrsm.org.uk
http://www.rsm.ac.uk

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