Patients Prefer End-of-Life Care in Their Location of Choice

Patients diagnosed with cancer want their doctors to ask them their desire location for end-of-life (EOL) care, according to a recent study published in the Journal of the National Comprehensive Cancer Network.

Comfort is extremely important when cancer patients are nearing the end of their life. Doctors and physicians play a role in assisting their patients find a place where they can die comfortably, improving the quality EOL care. Understanding patient choices and the reasoning for their preferred location will improve care settings and patient—physician interactions.

“Supporting people’s wish to die at home instead of at a hospital can reduce costs to the system," Amy Waller, PhD, of the Health Behavior Research Group at the University of Newcastle in Australia, said in a statement. "However, this may come at a significant personal cost to the patient and family. It also means that those without informal carers might need support from community palliative care services, and currently there are not enough to go around.”

This study wished to examine a patient’s preferred location of EOL care, the patient’s perceived benefits and worries of that location, the percentage of patients who had conversations with their doctor regarding EOL care locations, and whether patients wanted their doctors to inquire on their desired location of death.

At an Australian Oncology Outpatient Clinic, the researchers asked adults with a confirmed cancer diagnosis between September 2015 and January 2016 to participate in a cross-sectional survey. Patients who consented were given an at-home paper survey that asked questions regarding their preferred location of care, perceived benefits and worries, discussion of preferences with others, willingness to discuss preferences, and dying in their location of choice.

Out of the 203 surveys that were returned to the researchers, 47% of patients wished to die in their home or the home of a relative, 34% preferred to be cared for in a hospice or palliative care unit, and 19% preferred to spend the end of their life in a hospital. While 93% of patients wished to die in their preferred location, only 7% of patients had the discussion with their doctors and 41% discussed their preferences with their support persons. Patients kept their family and other support persons and access to expert medical care in mind when making their decision on the location of their death.

“Dying in the location of their choice is important to patients,” the authors concluded. “Although patients were willing to have healthcare providers ask them where they wished to die, few discussed it with their doctor. Given the overall variation in preferred location of EOL care among patients, healthcare providers should take a systematic approach to eliciting patient preferences. This can help ensure that reasons for patients' choices are expressed and understood, and that patients have the appropriate support to achieve their preferences.”