Cargando…

Delivering preference for place of death in a specialist palliative care setting

Over the last 10 years, one of the key themes of public policy in palliative care has been achievement of choice in place of death. In Marie Curie Hospice Edinburgh a baseline audit conducted in 2006 showed that only a small proportion (18%) of patients referred to hospice services died at home. The...

Descripción completa

Detalles Bibliográficos
Autores principales: Oxenham, David, Finucane, Anne, Arnold, Elizabeth, Russell, Papiya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: British Publishing Group 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4652739/
https://www.ncbi.nlm.nih.gov/pubmed/26734208
http://dx.doi.org/10.1136/bmjquality.u201375.w897
_version_ 1782401810298830848
author Oxenham, David
Finucane, Anne
Arnold, Elizabeth
Russell, Papiya
author_facet Oxenham, David
Finucane, Anne
Arnold, Elizabeth
Russell, Papiya
author_sort Oxenham, David
collection PubMed
description Over the last 10 years, one of the key themes of public policy in palliative care has been achievement of choice in place of death. In Marie Curie Hospice Edinburgh a baseline audit conducted in 2006 showed that only a small proportion (18%) of patients referred to hospice services died at home. The audit also revealed that only 31% of those who expressed a preference to die at home were able to do so, whereas 91% of those who chose a setting other than home achieved their preference. Overall achievement of preferred place of death was 56%. However a significant number of patients (29%) did not have a recorded preference. A programme of quality improvement has continued over the last 7 years to improve identification, communication and achievement of preferred place of death for all patients. The mechanisms to change practice have been: changes to documentation; changes to clinical systems to support use of documentation; support for clinical staff to recognise the value of discussing preferences; and support for clinical staff to develop new skills. In addition the programme has been incorporated into local clinical strategy and this has enabled gaps in service to be addressed with a new service to support early discharge of those patients who wish to die at home. A recent audit showed that all patients had a recorded preference or a documented reason why their preference was unclarified. One third of patients died at home – nearly double the proportion that died at home in the baseline audit. Seventy one per cent of patients who wished to die at home actually died at home – a substantial increase from 31% at baseline. Achievement of preferred place of death for patients wishing to die in the hospice remained high at 88%. The focus on assessment of preference for place of death has led to substantial improvements in the identification and achievement of preference for patients dying under the care of the hospice. Furthermore, it has been associated with an increase in the overall proportion of patients who die at home.
format Online
Article
Text
id pubmed-4652739
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher British Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-46527392016-01-05 Delivering preference for place of death in a specialist palliative care setting Oxenham, David Finucane, Anne Arnold, Elizabeth Russell, Papiya BMJ Qual Improv Rep BMJ Quality Improvement Programme Over the last 10 years, one of the key themes of public policy in palliative care has been achievement of choice in place of death. In Marie Curie Hospice Edinburgh a baseline audit conducted in 2006 showed that only a small proportion (18%) of patients referred to hospice services died at home. The audit also revealed that only 31% of those who expressed a preference to die at home were able to do so, whereas 91% of those who chose a setting other than home achieved their preference. Overall achievement of preferred place of death was 56%. However a significant number of patients (29%) did not have a recorded preference. A programme of quality improvement has continued over the last 7 years to improve identification, communication and achievement of preferred place of death for all patients. The mechanisms to change practice have been: changes to documentation; changes to clinical systems to support use of documentation; support for clinical staff to recognise the value of discussing preferences; and support for clinical staff to develop new skills. In addition the programme has been incorporated into local clinical strategy and this has enabled gaps in service to be addressed with a new service to support early discharge of those patients who wish to die at home. A recent audit showed that all patients had a recorded preference or a documented reason why their preference was unclarified. One third of patients died at home – nearly double the proportion that died at home in the baseline audit. Seventy one per cent of patients who wished to die at home actually died at home – a substantial increase from 31% at baseline. Achievement of preferred place of death for patients wishing to die in the hospice remained high at 88%. The focus on assessment of preference for place of death has led to substantial improvements in the identification and achievement of preference for patients dying under the care of the hospice. Furthermore, it has been associated with an increase in the overall proportion of patients who die at home. British Publishing Group 2013-08-21 /pmc/articles/PMC4652739/ /pubmed/26734208 http://dx.doi.org/10.1136/bmjquality.u201375.w897 Text en © 2013, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ http://creativecommons.org/licenses/by-nc/2.0/legalcode
spellingShingle BMJ Quality Improvement Programme
Oxenham, David
Finucane, Anne
Arnold, Elizabeth
Russell, Papiya
Delivering preference for place of death in a specialist palliative care setting
title Delivering preference for place of death in a specialist palliative care setting
title_full Delivering preference for place of death in a specialist palliative care setting
title_fullStr Delivering preference for place of death in a specialist palliative care setting
title_full_unstemmed Delivering preference for place of death in a specialist palliative care setting
title_short Delivering preference for place of death in a specialist palliative care setting
title_sort delivering preference for place of death in a specialist palliative care setting
topic BMJ Quality Improvement Programme
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4652739/
https://www.ncbi.nlm.nih.gov/pubmed/26734208
http://dx.doi.org/10.1136/bmjquality.u201375.w897
work_keys_str_mv AT oxenhamdavid deliveringpreferenceforplaceofdeathinaspecialistpalliativecaresetting
AT finucaneanne deliveringpreferenceforplaceofdeathinaspecialistpalliativecaresetting
AT arnoldelizabeth deliveringpreferenceforplaceofdeathinaspecialistpalliativecaresetting
AT russellpapiya deliveringpreferenceforplaceofdeathinaspecialistpalliativecaresetting