Realisation of preferred place of death: Could it be a palliative care indicator

There is little consensus regarding what outcomes can be used as clinical indicators to measure quality palliative care service provision. International literature suggests that palliative patients place importance on choosing their place of death and, for most, that place is home. This project, conducted in southern Queensland, surveyed bereaved carers as proxies for recently deceased palliative patients to explore patients’ realisation of preferred place of death as a possible clinical indicator. Of 248 carers, 143 (57.7%) indicated their loved one had expressed a preference for place of death: 68.5% of these nominated home, 18.9% preferred hospital and 12.6% hospice. Only 52.7% of patients with a preference were able to die in that environment. Patients who want to die at home are significantly less likely to die in their environment of choice than those who want to die in another place (2=64.2, df=6, p<.001). Reasons suggested by carers for loved ones not dying in their preferred place included symptom control, carer distress, lack of resources and change of mind. When carers were asked whether they were satisfied with the ultimate place of death, 92.5% indicated that they were. This did not differ significantly across those whose loved one had died in their preferred place and those who had not.

These preliminary data do not support the use of realisation of preferred place of death as a clinical indicator. They do suggest that more community palliative care capacity is required to support people to die at home should they choose to do so.