Eliciting and honouring end-of-life care preferences : a multiple methods study on place of death

Abstract

This chapter describes the value of "home" as the place of death and discusses the differences that exist across high-income countries in having this preference. The experiences of selected Asian, European, and North American countries are contrasted. Other than individual and clinical factors, sociodemographic changes also act in concert with shifts in caregiving and death culture to influence the organisation and operationalisation of health and social care services over time. Legal means are used in some countries to sanction the idea of self-determination in end-of-life care decision-making; and since the late 1990s, ACP has become a significant non-legalistic mechanism, through which end-of-life care preferences are made known. In some countries, changes to end-of-life care service delivery and financing have supported the shifts in deaths from inpatient to out-of-hospital care facilities. These forces shape, and act jointly with the availability of formal and informal care, to support the individual living at home. The research objective, and specific research questions to be addressed in this dissertation, are outlined in this chapter. Yoshiuchi, Fujita, Sawai, & Watanabe, 2011; Ishikawa et al., 2013), was instead sparse. Therefore, the current discourse about home deaths is, to a great extent The Canadian experience On the other hand, the case of Canada was not supported by deliberate policy changes specific to palliative care delivery. Between 1994 and 2004, there were rapid declines in hospital deaths from 78% to 61% and a corresponding increase in home deaths from 19% to 30% (Wilson et al., 2009). Although community-based palliative

A Study Protocol of Realist Evaluation of Palliative Home Care Program for Non-Cancer Patients in Singapore

“…Acute hospital utilization (emergency department (ED) attendances, inpatient admissions, intensive care unit (ICU) admissions and length of stay (LOS)) will be extracted backwards from the date of death for 1 month (30 days), 3 months (90 days) and 6 months (180 days). Concordance of actualized place of death with preferences discussed as part of ACP will be determined after death as described by Tan et al [ 32 ].…”