HS&DR Project - 08/1813/257 Back
|Project title||Understanding place of death for patients with non malignant conditions: a systematic literature review|
|SDO research theme||End of life / palliative care|
|Chief investigator||Dr Fliss Murtagh, King's College London|
|Co-investigators||Professor Irene Higginson, Dr Marjolein Gysels, Professor Scott Murray, Dr Cathy Shipman, Professor Sube Banerjee, Dr Claudia Bausewein, Ms Barbara Gomes, Dr Bridget Johnston|
|Contractor||King's College London|
|Start date||January 2010|
|Publication date||September 2012|
|Plain English summary|
Improving care towards the end of life is an important priority for the public and for health professionals. Palliative care and hospices have done much to improve the care of those with advanced cancer, but ...
Improving care towards the end of life is an important priority for the public and for health professionals. Palliative care and hospices have done much to improve the care of those with advanced cancer, but only about one in four of all UK deaths are due to cancer. Many more people will die with other conditions, such as heart or respiratory failure, kidney failure, stroke, or dementia. These patients spend more time in acute hospital care, and are less likely to die at home in familiar surroundings.They have similar levels of symptoms, but access fewer services, and their preferences for place of care and death are less often met. The course of their illness is often more variable and harder to predict. Understanding these differences and so improving care for those with non-cancer diseases is important, but needs to be underpinned by good research evidence to deliver best outcomes for patients and families.This project aims to review, with rigour and detail, the existing research on preferences regarding place of care and death, and factors influencing place of death for those with noncancer conditions, to inform better delivery of care, and to identify research gaps. We will draw together the evidence on 1) where people with non-cancer diseases would prefer to be cared for and to die, 2) what determines this preference, 3) which factors influence their actual place of death, and 4) key transitions (such as admission into hospital) in end of life care.To do this, we will use robust well-established techniques to find the relevant research, undertake rigorous assessment of the quality of each study, and then assess the overall strength of the evidence for each area. We will carefully integrate findings to provide a complete picture of what is currently known. Findings will be contrasted across ages, across diseases, and across stage of disease. Areas where more evidence is needed will be identified. We will then make detailed recommendations to inform practice, improve services for people with advanced non cancer conditions, and indicate what future research is needed to continue to inform future improvements in care.
Background: Compared with advanced cancer, those with advanced non-malignant conditions spend more time in acute hospital care and are less likely to die at home. Their preferences for place of care/death may be less often ...
Background: Compared with advanced cancer, those with advanced non-malignant conditions spend more time in acute hospital care and are less likely to die at home. Their preferences for place of care/death may be less often met. Planning equitable care for these patients is increasingly important and needs to be evidence-based to deliver best outcomes.Aim: To systematically identify, appraise, synthesise and report the evidence on 1) the extent to which people with advanced non-malignant conditions want to die at home, 2) what determines their preferences for place of care/death, 3) which factors are associated with place of death, and 4) key transitions in end-of-life care. This review will focus on six conditions: Chronic Cardiac Failure, Chronic Obstructive Pulmonary Disease, Dementia, Stroke, End-stage Kidney Disease, and Long-term Neurological Conditions.Methods: Through a systematic literature review, to identify, critically appraise the evidence in terms of the quantity, quality, and strength, synthesize and report it and identify gaps in the existing evidence. A comprehensive search will be conducted to identify evidence across preferences, factors, and transitions. Key transitions in care will be defined early in the project, and are expected to include transitions in setting of care (such as admission to hospital from home), and transitions in focus of care (such as from curative to palliative treatment). Outcomes: Findings will be synthesized, reported, and compared across ages and conditions. Factors associated with place of death will be analysed for direction of effect (for/against home death) and the relative impact of different health and social care resources on place of death will be reported, using odds ratios where possible. A meta-ethnography will integrate the qualitative evidence on what determines or changes preferences for place of care/death. Detailed recommendations will be made to inform practice and improve care, and highlight future research needs.
|Outputs||no published journal articles or book outputs notified|
|Commissioning brief||Download (PDF 225Kb)|
|Executive summary||Download (PDF 304Kb)|
|Final report||Download (PDF 7,115Kb)|
|Appendix 1||Download (PDF 472Kb)|
|Keywords||non-malignant conditions, place of care/death, acute hospital care, end-of-life care, Chronic Cardiac Failure, Chronic Obstructive Pulmonary Disease, Dementia, Stroke, End-stage Kidney Disease, Long-term Neurological conditions, systematic literature review, palliative treatment, home death, key transitions|
|Addendum||This project was commissioned by the NIHR Service Delivery and Organisation (NIHR SDO) programme under the management of the National Coordinating Centre for the Service Delivery and Organisation (NCCSDO) which was based at the London School of Hygiene and Tropical Medicine (LSHTM). The project was managed by NCCSDO until 31 March 2009. Management of the NIHR Service Delivery and Organisation (SDO) programme and its portfolio of projects transferred to the National Institute for Health Research Evaluations, Trials and Studies Coordinating Centre (NETSCC) based at the University of Southampton from 1 April 2009.|