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Is home the best place to die?

  • Comments (27)

Is home the best place to die? What do you think?

A new study based on Office for National Statistics (ONS) data has found more people are spending their final hours at home. The rise in home deaths appears to be most pronounced among people with cancer. The trend before this was a decline in deaths at home which almost halved from 1974 to 2003. Home deaths increased for the first time since 1974 among people aged 85 and over but this age group was the least likely to die at home of any adult age group over the study period.

  • Comments (27)

Readers' comments (27)

  • michael stone

    'Is home the best place to die?'

    Explain the likely prognosis of 'dying' to the patient, in terms of 'what it will probably feel like'. Explain any different treatment and support options, regarding differences between different locations.

    Then ask the patient what he or she wants to do: you then have the 'best available' answer to the question.

    And allow patient's to change their choices, if they wish to, as their own individual experience of dying increases as they 'die'.

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  • Anonymous

    I think this is one of the questions that we should ask our patients, certainly those who are in any palliative care situation, not just cancer patients.

    I think that nurses are sometimes afraid of mentioning death to patients when we talk to them in assessments etc. But I think that older patients quite often want to talk about death and discuss their wishes and needs as the time approaches and this is often ignored by nurses because of this fear.

    I worked as an elderly and palliative care specialist practitioner and whilst developing the role it became quite apparent that death, whilst not taking up a whole conversation, is a topic that does need dicussion with the patients and their families.

    I know I would like to make the decision when my time comes.

    An old palliative care patient of mine once said, "You'll have seen people dying many times and that gives me faith in you knowing what you are doing and talking about. But I only get one chance of getting this right and that scares me".

    Reassurance that there is nothing set in stone and that patients can change their mind as the are dying quite often helps alay some of the fears that patients have.

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  • Anonymous

    the best place is surely according to personal and patient preference.

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  • Anonymous

    Anonymous | 25-Jan-2012 12:30 pm
    I would also add to my comment that it depends on the patient's symptoms and level of equipment and support they have needed and its availability and on their home and personal circumstances.

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  • michael stone

    Anonymous | 25-Jan-2012 12:10 pm

    I like your post - in particular this is crucial to 'understanding' of dying:

    'An old palliative care patient of mine once said, "You'll have seen people dying many times and that gives me faith in you knowing what you are doing and talking about. But I only get one chance of getting this right and that scares me".'

    As is what follows from it, the point you mentioned that patients can change their minds.

    But you were a specialist in palliative care - but I think many nurses, especially young and inexperienced nurses who have no great experience of palliative care and who have not been involved when their own relatives have been dying, simply do not understand 'dying' as well as you do.

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  • Anonymous

    michael stone | 28-Jan-2012 11:50 am

    damning nurses again!

    you might as well accept that none of us, even those of us with long years in the profession, who have supported many dying patients and their relatives, simply do not understand and don't know their job that they have been trained to do and have gathered experience in!

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  • Anonymous

    Attention Michael Stone

    why do you not write an article of your own where you can put forward all your issues which are bothering you, and with your specific questions and then see if you can get the more precise answers you are looking for, for once and for all.

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  • Anonymous

    actually, i think michael may have identified a training need. the first time most of my colleagues, including the experienced ones, hear of the liverpool care pathway is when i mention it. i'm sure my trust isn't the only one.

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  • Anonymous

    the LCP is not the only method and may not even be the best one and not all hc institutions choose to use it.

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  • Anonymous

    As a nurse - and a patient with a life-threatening illness - I can quite clearly state that my first instinct on hearing the diagnosis was to state unequivovally to my husband that I wanted to die at home with people who love me. The difficulty for patients is that, no matter how experienced or caring the nuises, they are not their family and they do not 'love'[ them in the way that their families do. They may be very caring and concerned to do their best but it simply cannot be the same. This does not deny their abilities or skills as nurses but highlights their limitations by the very nature of who they are. It is an unavoidable fact not a criticism of who and what they are.

    Secondly, as my husband points out, the time leading up to the patient's death is considerably less stressful because of the problems of being at the bedside for long and unpredictable periods. And he speaks from experience having supported his first wife through a similar illness at home and had a son die in hospital.

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