Exploring why some terminally ill people die in hospital when home was their preferred choice

Abstract

Objective: This small study was designed to gain a better understanding of issues that led to hospital admission of palliative care clients who had a preference for home death, but died in hospital.

Design: A mixed method approach was chosen for the study using descriptive analysis of routinely collected client demographic and clinical data, and conventional content analysis of case note entries.

Setting: The study was undertaken in two community based palliative care services located in rural South Australia.

Subjects: The case notes of fourteen deceased adults registered with the Northern Yorke Peninsula and Port Pirie Palliative Care Services, with a recorded preferred site of death (PSD) of home and who died in hospital were studied.

Main outcome measure: Understanding of issues that may have led to hospital admission of palliative care clients who had a preference for home death but who died in hospital.

Results: The findings reported here focus only on the qualitative aspect of the study. Issues that may lead to hospital admission include: unstable symptoms, deteriorating condition, client/caregiver decision making, lack of services over twenty four hours and the caregiver’s ability to manage client care.

Conclusion: Services can now consider these findings and develop local strategies to improve support for clients with a preference to die at home, and in particular, those that focus on improving caregiver training and information.