Opinions of patients with cancer on the relative importance of place of death in the context of a ‘good death’

Waghorn, Melanie; Young, Holly; Davies, Andrew

doi:10.1136/bmjspcare-2011-000041

Cited by 33 publications

(34 citation statements)

References 15 publications

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“…25,27 Most patients want to be cared for at home and want to die at home if they can, 33 but they also want to receive a good level of care irrespective of their location. 24 Provision of community palliative care services in par ticular has a key role in improving symptom control and enabling patients to be cared for at home. 64 Many-but not all-patients want to make plans for their future care, and this requires the support of trained health care professionals.…”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25] Patients with advancedstage cancer found that the most important factors associated with a 'good death' were "to have my pain/symptoms well controlled", "to not be a burden to my family", "to have sorted out my personal affairs", "to be involved in decisions about my care" and "to be mentally alert until death". Defining a 'good death' will be challenging in many situations, and may require a combination of expressed preferences from patients and subsequent correlation with feedback from their bereaved carers.…”

Section: Patients' End-of-life Preferencesmentioning

confidence: 99%

“…37 Of 9,344 participants, between 51% (95% CI 48-54%) in Portugal and 84% (95% CI 82-86%) in the Netherlands would prefer to die at home. Factors Box 2 | Attributes of a "good death" for patients [24][25][26][27] ■ Being in control and mentally alert until death, involved in decisions about care ■ Being comfortable (pain and other symptoms controlled) ■ Recognition of impending death and a sense of closure ■ Affirmation/value of the self, with beliefs and values honoured ■ Trust in care providers, including a strong patient-physician therapeutic alliance ■ Relationships optimized with family and friends, burden minimized to family ■ Family cared for, including bereavement support ■ Death in preferred place of care ■ Religious prayer or meditation ■ Personal affairs in order ■ Leaving a legacy associated with a preference for home death included: younger age up to 70 years (Germany, the Netherlands, Portugal, Spain), prioritizing keeping a positive atti tude (Germany, Spain) and wanting to involve family in decisions if incapable (Flanders, Portugal). 37 This data suggests that location of death is an important factor to consider when dealing with the endoflife care p references of patients with cancer.…”

Section: The Importance Of Place Of Deathmentioning

confidence: 99%

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End-of-life care—what do cancer patients want?

2013

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Patients with cancer frequently suffer from debilitating physical symptoms and psychological distress, particularly at the end of life. Interventions to help alleviate these problems are often complex and multifactorial. Palliative care services and therapeutic interventions have developed in a variable manner, often with limited evaluation of clinical effectiveness and affordability, resulting in a relatively weak evidence base. The health care provided to patients with advanced-stage cancer does not always correlate with what is known about their preferences for care. In this Review, we discuss the preferences of patients with cancer regarding their end of life care, including the importance of early provision of palliative care, and the central role of advance care planning in meeting patients' preferences. It has been shown that many patients with cancer wish to die at home. We discuss the factors that contribute to the place of death, including environmental factors, disease-specific issues, and the availability of resources. There has been a recent upward trend in the number of patients with cancer who die in their preferred place of care, and important contributors--such as community palliative care, advance care planning, and improvements in palliative care services as a result of robust research studies--are considered.

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Section: Discussionmentioning

confidence: 99%

Section: Patients' End-of-life Preferencesmentioning

confidence: 99%

Section: The Importance Of Place Of Deathmentioning

confidence: 99%

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End-of-life care—what do cancer patients want?

2013

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“…(Henry, 2015, para 53). Not being 'a burden' on the rest of the family, according to another study, is a high priority for many people at the end of life (Waghorn, Young, & Davies, 2011); for example, a person's choice about where to be cared for may reflect how they perceive their carers' rather than their own needs (Borgstrom, 2014). This latter study of EOLC shows how patients make 'choices' as relational selves, often struggling to make these choices in the way health policy demands of them.…”

Section: On Whose Behalf?mentioning

confidence: 99%

Choice and compassion at the end of life: A critical analysis of recent English policy discourse

Borgstrom

Walter

2015

Social Science & Medicine

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End of life care in England has recently been framed by two very different discourses. One (connected to advance care planning) promotes personal choice, the other promotes compassionate care; both are prominent in professional, policy and media settings. The article outlines the history of who promoted each discourse from 2008 to early 2015, when, why and how and this was done.Each discourse is then critically analysed from a standpoint that takes account of bodily decline, structural constraints, and human relationality. We focus on the biggest group of those nearing the end of their life, namely frail very old people suffering multiple conditions. In their care within contemporary healthcare organisations, choice becomes a tick box and compassion a commodity.Informed choice, whether at the end of life or in advance of it, does not guarantee the death the person wants, especially for those dying of conditions other than cancer and in the absence of universally available skilled and compassionate care. Enabling healthcare staff to provide compassionate, relational care, however, implies reversing the philosophical, political and financial direction of healthcare in the UK and most other Anglophone countries. KeywordsEngland, end of life care, choice, compassion, discourse, old age, relational ethics, governmentality 2 Research Highlights• The 'choice' agenda arises out of (cancer) palliative care.• The 'compassion' agenda arises out of elder care scandals.• Compassion signifies care as a relationship rather than a commodity.• Compassion can be undermined by an overemphasis on autonomous individuals.

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“…5,6 There is evidence to suggest that focusing on the place of death may be less important than focusing on factors that may create a more positive experience of end-of-life (EOL) care. 8 What is a good death?…”

mentioning

confidence: 99%