P-39 Learning how to die

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Abstract

Background

Attainment of preferred place of death has become an indicator of quality of palliative care received by patients. Not only does it realise patient‘s ideal death, it also involves the patient and their families in the experience- through discussions to prepare them for the possible scenarios and defining priorities of the dying experience. Advanced care planning discussions will question reasons for preference. Will previous experience with death and dying be a factor?

Method

Purposive sampling by questionnaire was conducted among staff of Pilgrim’s Hospice. It posed a hypothetical situation of dying from an illness, and where would one’s preferred place of death be and reasoning behind choice was asked. 16 questionnaires was returned and analysed qualitatively.

Results

Home was the most popular choice of place of death, as is with the general population. Reasons were linked to personal attachments to homes and families. However, staff are experienced with disease and dying and understood that conditions can deteriorate and indicated a second choice of place of death without prompting. In such circumstances, the hospice was a popular second option should a home death not be achievable. The largest reason for such choice was the standard of care, followed by considerations of families’ needs.

Conclusion

Experience with other’s dying enables one understand and conceptualise realistically the trajectory of death. Staff were more open to alternative options understanding care complications can arise whereas in the average population, such realisation tends to occur when care difficulties start to be experienced. Reasonings behind choice of death at home were aligned to that of the general population, whilst choice of death at hospice focused on the services the hospice could provide the dying and their families. This could highlight the role palliative care staff can bring into advanced care planning discussions when helping patients weigh decisions.

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