Home is not always the best or preferred place to die, argues expert

The people at home has to have an effect on this.

http://www.eurekalert.org/pub_releases/2015-10/b-hin100515.php

Public Release: 7-Oct-2015
Home is not always the best or preferred place to die, argues expert
BMJ

The widely held belief that home is the best and preferred place of death is questioned by an expert writing in The BMJ this week.

The UK government has marked place of death as a key indicator for the quality of end of life care. This is based on the idea that most people would prefer to die at home, but the evidence for this is not as strong as previously thought, argues Kristian Pollock from the University of Nottingham.

She writes that "focusing on place of death as the key indicator of quality in end of life care distracts attention from the experience of dying," and calls for "more attention and resources to be spent on improving end of life care wherever this occurs, in hospitals or elsewhere."

Dr. Pollock argues that more research is needed regarding what matters most to people at the end of life. For example, the difference between people's preference regarding place of care, as opposed to place of death, is often overlooked.

In addition, she says a preference to die at home does not mean that place of death is the highest priority. Evidence suggests that dying in pain is the greatest concern of patients and the public, and that 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 adds. "The person may have been alone, inadequately supported, in pain, distressed, and fearful."

Hospitals have become widely regarded as inappropriate and undesirable places to die, she explains. There are concerns about poor quality of care and the high costs incurred by deaths in hospital.

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