Geographical understanding of variation in place of death: the role of care services and end of life care improvement (GUIDE_Care Services)
Investigating whether the location of palliative and end of life care services in south London influences place of death
Does the location of palliative and end of life care services make a difference to where people die? Is a patient more likely to die at home or in hospital if he or she lives in a neighbourhood where there are community-based palliative care services, for example?
Research studies and surveys have shown that the majority of people say they want to die at home – but hospital is the most common place of death. Enabling more people to die in their place of choice is one of the aims of the government's End of Life Care Strategy, published in 2008(1).
In England, between 2008 and 2010, 55 per cent of deaths were in hospital, 20 per cent at home, 18 per cent were in a care home, and five per cent in a hospice. London had the highest percentage of deaths in hospital (61 per cent)(2).
CLAHRC South London palliative and end of life care researchers at the Cicely Saunders Institute, King's College London have carried out a scoping exercise to identify the location of palliative and end of life care related services provided by hospices and hospitals (including community-based services) in south London.
They have cross-referenced that information with data about people's place of death that is contained in over 60,000 death certificates (available from the Office for National Statistics).
The project, which was led by Dr Gao Wei, completed in June 2016. The report of the main findings, Measuring geographical accessibility to palliative and end of life (PEoLC) related facilities: a comparative study in an area with well-developed specialist palliative care (SPC) provision, was published in January 2017.
Dr Gao and her colleagues have previously carried out research using the information contained in death certificates issued in England between 1984 to 2010 to find out what kind of people are more likely to die at home, and which causes of death are more likely to mean people die in hospital. 'We found out that older people, single or divorced people, people with leukaemia and people living in more deprived areas are more likely to die in hospital,' she says.
This analysis of routine data has to date been carried out under the umbrella identity of GUIDE_Care (Geographical and temporal variations in place of death in England [1984-2010]: Understanding trends and associated factors to improve end-of-life care). Work has previously been funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme, Marie Curie Cancer Care and Public Health England.
'Analysing data that is routinely collected, such as information recorded on death certificates, helps identify and reduce inequalities in the care that is available,' says Dr Gao. Dr Gao and her colleagues are now scaling up their work to understand the relationship between place of death and factors such as service location, provision and capacity at the national level through the Guide_Care Services project outlined below.
(1) The End of Life Care Strategy: promoting high quality care for adults at the end of their life, Department of Health, 2008.
(2) Patterns of end of life care in England, 2008 to 2010, published by Public Health England, 2014.