Patient choice and dying at home.

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The study, published in the British Journal of General Practice, was set in Scotland and examined anticipatory care planning (ACP) – a tool which follows the same principles as Advance Care Planning (the use of which is being encouraged across England and Wales). ACP sets out a patient’s wishes in the event of a sudden deterioration in health, and is based on conversations between patients, their loved ones and healthcare professionals.

 

The study found that using an ACP doesn’t extend the life of patients when compared to those that don’t have an ACP. Rather, it led to less patients dying in hospital and more dying at home or in their care home.

 

There is often the assumption that healthcare professionals must do all they can to keep people alive. However, we know that the majority of adults in the UK would want comfort care only if they were dying and not be kept alive unnecessarily. Crucially, ACP leads to an increase in choice (allowing the patient to set the level of life-prolonging treatment) and these choices being formally recorded.

 

This is good news and comes not long after a report was published in Palliative Medicine journal which found that dying at home is becoming more prevalent in Britain, and that home deaths are increasing for the first time since 1974 amongst people aged 85 years and over. Coming out of this report, some key areas need addressing:

  1. that the rise in home deaths is more pronounced among those with cancer – there now needs to be a focus on other conditions;
  2. that there is still marked variation in the delivery of end-of-life care across the UK;
  3. whether patients and their families experience better care when dying at home when compared to those who die in hospitals, hospices and nursing homes.

There is no doubt that discussing end-of-life preferences can be difficult both for the patient, their family and their doctor. However, such conversations (which can also be recorded using an Advance Decision) have an important part to play in helping ensure that dying patients’ wishes are respected.