Research news: The preferences of older adults receiving palliative care compared across 3 countries
30th November 2017
Research teams based at the Cicely Saunders Institute, Mount Sinai Hospital in New York, and Trinity College Dublin have been investigating the choices and preferences of older adults to see how these compare across the 3 countries. What factors influence preferences for place of care and treatment, and the actual site of death? The work is part of the BuildCARE programme funded by The Atlantic Philanthropies via Cicely Saunders International.
Achieving choice is perceived as a marker of quality. But the influences that shape these preferences are poorly understood, especially among older adults. Researchers decided to determine and compare factors associated with preferences for place of care and death, with actual place of death, to see if their preferences were being met.
Adults over 65 years of age were recruited from hospital based multi-professional palliative care services in London, Dublin and New York. These patients were followed for at least 17 months. The patients received consultation on hospital wards, support from clinical teams and/or outpatient services. The patients were funded by the National Health Service or relevant health insurance. The New York service additionally had 10 inpatient beds. Face to face interviews recorded patients’ most and least preferred place of death. The researchers also recorded the patients priorities for care, and demographic and clinical information.
Home was the most preferred place of death (56%) followed by inpatient palliative care/hospice units (22%). Hospital was least preferred (25%), followed by nursing home (20%) and home (16%); hospice/palliative care unit was rarely least preferred (4%). Most respondents prioritised improving quality of life, either alone (54%), or equal with life extension (39%); few (3%) chose only life extension. There were no significant differences between London, New York and Dublin.
Home was the most common first preference. However it is polarising. For 16% it is the least preferred. Inpatient palliative care unit was the second most preferred place. It was rarely least preferred, and was not often achieved for those who wanted to die there. More services are needed, particularly community support and palliative care units, to support meaningful patient choice.
Higginson IJ, Daveson BA, Morrison RS, Yi D, Meier D, Smith M, Ryan K, McQuillan R, Johnston BM, Normand C; BuildCARE. 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 Nov 23;17(1):271. doi: 10.1186/s12877-017-0648-4