References

Abarshi E, Echteld M, Van den Block L, Donker G, Deliens L, Onwuteaka-Philipsen B. Transitions between care settings at the end of life in The Netherlands: results from a nationwide study. Palliat Med. 2010; 24:(2)166-174 https://doi.org/10.1177/0269216309351381

Bone AE, Gao W, Gomes B Factors associated with transition from community settings to hospital as place of death for adults aged 75 and older: a population-based mortality follow-back survey. J Am Geriatr Soc. 2016; 64:(11)2210-2217 https://doi.org/10.1111/jgs.14442

Critical Appraisal Skills Programme. CASP checklists. 2018. https://casp-uk.net/casp-tools-checklists/ (accessed 26 June 2019)

Centre for Reviews and Dissemination. Systematic reviews. 2008. http://tinyurl.com/yxwopfl4 (accessed 26 June 2019)

Choice in End of Life Programme Board. What's important to me. A review of choice in end of life care. 2015. http://tinyurl.com/y3znrg5t (accessed 22 June 2019)

Collis E, Al-Qurainy R. Care of the dying patient in the community. BMJ. 2013; 347 https://doi.org/10.1136/bmj.f4085

Coombs MA, Parker R, de Vries K. Managing risk during care transitions when approaching end of life: a qualitative study of patients' and health care professionals' decision making. Palliat Med. 2017; 31:(7)617-624 https://doi.org/10.1177/0269216316673476

De Korte-Verhoef MC, Pasman HR, Schweitzer BP, Francke AL, Onwuteaka-Philipsen BD, Deliens L. General practitioners' perspectives on the avoidability of hospitalizations at the end of life: a mixed-method study. Palliat Med. 2014; 28:(7)949-958 https://doi.org/10.1177/0269216314528742

De Korte-Verhoef MC, Pasman HRW, Schweitzer BPM, Francke AL, Onwuteaka-Philipsen BD, Deliens L. How could hospitalisations at the end of life have been avoided? A qualitative retrospective study of the perspectives of general practitioners, nurses and family carers. PLoS One. 2015; 10:(3) https://doi.org/10.1371/journal.pone.0118971

Department of Health. End of life care strategy. Promoting high quality care for all adults at the end of life. 2008. https://tinyurl.com/o38nlej (accessed 26 June 2018)

Department of Health. One year on: the government response to the review of choice in end of life care. 2017. http://tinyurl.com/y7s98e3m (accessed 26 June 2018)

Dying Matters. Frequently asked questions. 2017. https://www.dyingmatters.org/page/frequently-asked-questions (accessed 1 July 2018)

Gardiner C, Ward S, Gott M, Ingleton C. Economic impact of hospitalisations among patients in the last year of life: an observational study. Palliat Med. 2014; 28:(5)422-429 https://doi.org/10.1177/0269216313517284

Gill TM, Gahbauer EA, Han L, Allore HG. The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people. BMJ. 2015; 350 https://doi.org/10.1136/bmj.h2361

Gomes B, Higginson IJ, Calanzani N Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann Oncol. 2012; 23:(8)2006-2015 https://doi.org/10.1093/annonc/mdr602

Gott M, Frey R, Robinson J The nature of, and reasons for, ‘inappropriate’ hospitalisations among patients with palliative care needs: a qualitative exploration of the views of generalist palliative care providers. Palliat Med. 2013; 27:(8)747-756 https://doi.org/10.1177/0269216312469263

Hanratty B, Holmes L, Lowson E Older adults' experiences of transitions between care settings at the end of life in England: a qualitative interview study. J Pain Symptom Manage. 2012; 44:(1)74-83 https://doi.org/10.1016/j.jpainsymman.2011.08.006

Henson LA, Higginson IJ, Daveson BA ‘I'll be in a safe place’: a qualitative study of the decisions taken by people with advanced cancer to seek emergency department care. BMJ Open. 2016; 6:(11) https://doi.org/10.1136/bmjopen-2016-012134

Higginson IJ, Sarmento VP, Calanzani N, Benalia H, Gomes B. Dying at home—is it better: a narrative appraisal of the state of the science. Palliat Med. 2013; 27:(10)918-924 https://doi.org/10.1177/0269216313487940

Higginson IJ, Daveson BA, Morrison RS Social and clinical determinants of preferences and their achievement at the end of life: prospective cohort study of older adults receiving palliative care in three countries. BMC Geriatr. 2017; 17:(1) https://doi.org/10.1186/s12877-017-0648-4

Hunt KJ, Shlomo N Addington-Hall J. End-of-life care and achieving preferences for place of death in England: results of a population-based survey using the VOICES-SF questionnaire. Palliat Med. 2014; 28:(5)412-421 https://doi.org/10.1177/0269216313512012

Jack B, O'Brien M. Dying at home: community nurses' views on the impact of informal carers on cancer patients' place of death. Eur J Cancer Care (Engl). 2010; 19:(5)636-642 https://doi.org/10.1111/j.1365-2354.2009.01103.x

Krawczyk M, Gallagher R. Communicating prognostic uncertainty in potential end-of-life contexts: experiences of family members. BMC Palliat Care. 2016; 15:(1) https://doi.org/10.1186/s12904-016-0133-4

Lakasing E, Kulkarni S, Sparkes C, RaviChander R. A practice-based survey of patients dying in hospital: can we do more to support end-of-life care at home?. Br J Community Nurs. 2014; 19:(3)130-133 https://doi.org/10.12968/bjcn.2014.19.3.130

O'Brien M, Jack B. Barriers to dying at home: the impact of poor co-ordination of community service provision for patients with cancer. Health Soc Care Community. 2010; 18:(4)337-345 https://doi.org/10.1111/j.1365-2524.2009.00897.x

Office for National Statistics. National survey of bereaved people (VOICES) England 2015'. 2016. http://tinyurl.com/ycnmo6z6 (accessed 26 June 2019)

Reyniers T, Houttekier D, Cohen J, Pasman HR, Deliens L, Deliens L. What justifies a hospital admission at the end of life? A focus group study on perspectives of family physicians and nurses. Palliat Med. 2014; 28:(7)941-948 https://doi.org/10.1177/0269216314522317

Reyniers T, Deliens L, Pasman HR Reasons for end-of-life hospital admissions: results of a survey among family physicians. J Pain Symptom Manage. 2016; 52:(4)498-506 https://doi.org/10.1016/j.jpainsymman.2016.05.014

Seal K, Murray CD, Seddon L. Family stories of end-of-life cancer care when unable to fulfill a loved one's wish to die at home. Palliat Support Care. 2015; 13:(3)473-483 https://doi.org/10.1017/S1478951514000017

Smith AK, McCarthy E, Weber E Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff. 2012; 31:(6)1277-1285 https://doi.org/10.1377/hlthaff.2011.0922

Spilsbury K, Rosenwax L, Arendts G, Semmens JB. The impact of community-based palliative care on acute hospital use in the last year of life is modified by time to death, age and underlying cause of death. A population-based retrospective cohort study. PLoS One. 2017; 12:(9) https://doi.org/10.1371/journal.pone.0185275

World Health Organization. Palliative care. 2018. https://tinyurl.com/ya854ux8 (accessed 22 June 2019)

Yang N, Ornstein KA, Reckrey JM. Association between symptom burden and time to hospitalization, nursing home placement, and death among the chronically ill urban homebound. J Pain Symptom Manage. 2016; 52:(1)73-80 https://doi.org/10.1016/j.jpainsymman.2016.01.006

A review of the literature on family decision-making at end of life precipitating hospital admission

11 July 2019
Professional
02 July 2019
Volume 28 · Issue 13

Abstract

Around 70% of people would prefer to die at home, yet around 50% die in hospital, according to Dying Matters. In collaboration with a local hospice, a literature review was undertaken to address the question: ‘what factors precipitate admission to hospital in the last few days of a person's life for those who had expressed a preference to die at home?’ Four electronic databases were searched, with a date range of 2008 to 2018. After 80 articles were screened, 13 were included in the review. The findings identified a number of barriers experienced by people with non-cancer conditions nearing the end of life and their family carers, which inhibit the transition to end-of-life care. The findings suggest that hospice support for non-cancer patients with a deteriorating health trajectory needs to precede patient and family recognition that end-of-life care is needed.

This article sets out to answer the following question by reviewing relevant literature from 2008 to 2018: ‘what factors precipitate admission to hospital in the last few days of a person's life for those who had expressed a preference to die at home?’

The question was identified by a local hospice as an important question for non-cancer patients who, despite expressing a preference for a home death, frequently end up dying in hospital. Pressure group Dying Matters (www.dyingmatters.org) estimates that around 70% of people would prefer to die at home, yet around 50% die in hospital. Promoting patient choice in treatment, management and location of care, including place of death, is core to several UK and international policy drivers (Higginson et al, 2013; Choice in End of Life Programme Board, 2015; Department of Health (DH), 2017; World Health Organization, 2018). These policies are supported by initiatives designed to reshape primary and community care and to reduce hospital admission at the end of life (DH, 2008).

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End of life
Palliative care
Non-cancer
Preferred place of dying
Care of the dying
Hospice