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Exploring preferences for place of death with terminally ill patients: qualitative study of experiences of general practitioners and community nurses in England

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Munday, Dan, Petrova, M. and Dale, Jeremy, 1958-. (2009) Exploring preferences for place of death with terminally ill patients: qualitative study of experiences of general practitioners and community nurses in England. BMJ, Vol.339 . Article:b2391. ISSN 0959-535X

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Official URL: http://dx.doi.org/10.1136/bmj.b2391

Abstract

Objective To explore the experiences and perceptions of general practitioners and community nurses in discussing preferences for place of death with terminally ill patients. Design Qualitative study using semistructured interviews and thematic analysis. Participants 17 general practitioners and 19 nurses (16 district nurses, three clinical nurse specialists). Setting 15 general practices participating in the Gold Standards Framework for palliative care from three areas in central England with differing socio-geography. Practices were selected on the basis of size and level of adoption of the standards framework. Results All interviewees bar one had experience of discussing preferred place of death with terminally ill patients. They reported that preferences for place of death frequently changed over time and were often ill defined or poorly formed in patients’ minds. Preferences were often described as being co-created in discussion with the patient or, conversely, inferred by the health professional without direct questioning or receiving a definitive answer from the patient. This inherent uncertainty challenged the practicability, usefulness, and value of recording a definitive preference. The extent to which the assessment of enabling such preferences can be used as a proxy for the effectiveness of palliative care delivery is also limited by this uncertainty. Generally, interviewees did not find discussing preferred place of death an easy area of practice, unless the patient broached the subject or led the discussions. Conclusions Further research is needed to enable development of appropriate training and support for primary care professionals. Better understanding of the importance of place of death to patients and their carers is also needed.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Terminally ill -- Psychology, Terminal care -- Social aspects, Place (Philosophy), Palliative treatment -- Great Britain
Journal or Publication Title:	BMJ
Publisher:	BMJ Group
ISSN:	0959-535X
Date:	15 July 2009
Volume:	Vol.339
Number of Pages:	9
Page Range:	Article:b2391
Identification Number:	10.1136/bmj.b2391
Status:	Peer Reviewed
Access rights to Published version:	Open Access
Funder:	Macmillan Cancer Support (Great Britain) (MCS)
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URI:	http://wrap.warwick.ac.uk/id/eprint/2153