Home not always the best place to die: expert

The widely held belief that home is the best and preferred place of death may be a myth, according to a UK expert, who calls for more attention and resources to be spent on improving end of life care.
"Focusing on place of death as the key indicator of quality in end of life care distracts attention from the experience of dying," said Kristian Pollock from the University of Nottingham in the UK.
"More attention and resources to be spent on improving end of life care wherever this occurs, in hospitals or elsewhere," she said.
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.

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 added.

"The person may have been alone, inadequately supported, in pain, distressed, and fearful," Pollock wrote in The BMJ.
Hospitals have become widely regarded as inappropriate and undesirable places to die. There are concerns about poor quality of care and the high costs incurred by deaths in hospital, she said.

However, hospitals may be preferred by patients who see them as places of safety and effective control of symptoms, especially for those who suffer distress and pain.
Many patients wish to avoid imposing a burden on their families and may prefer to transfer responsibility for care from home to hospital, she said.
She added that it is important to recognise and accommodate the diversity of patient preferences for place of death.
"When patients wish to die at home, every effort should be made to achieve this outcome. However, until resources are in place to adequately and equitably support home deaths, the current promotion of patient choice risks raising expectations that are not realised," she said.

Pollock said that as hospitals will remain the most common place of death for the foreseeable future, instead of "neglecting and disregarding the hospital as a site of terminal care, much greater thought and adequate resources must be directed to enabling hospitals to provide excellent support for dying patients and their families.