Published 15 July 2009, doi:10.1136/bmj.b2391
Cite this as: BMJ 2009;339:b2391

Research

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

Daniel Munday, associate clinical professor in palliative medicine, Mila Petrova, research fellow, Jeremy Dale, professor of primary care

1 Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL

Correspondence to: D Munday d.munday{at}warwick.ac.uk

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.

© Munday et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Death rarely desired, anywhere
Stephen Workman
BMJ 2009 339: b3265. [Extract] [Full Text]

Let’s talk about assisted dying
Fiona Godlee
BMJ 2009 339: b2883. [Extract] [Full Text]

Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study
Allison Worth, Tasneem Irshad, Raj Bhopal, Duncan Brown, Julia Lawton, Elizabeth Grant, Scott Murray, Marilyn Kendall, James Adam, Rafik Gardee, and Aziz Sheikh
BMJ 2009 338: b183. [Abstract] [Full Text] [PDF]

Informed consent and palliative chemotherapy
Daniel F Munday and E Jane Maher
BMJ 2008 337: a868. [Extract] [Full Text]

Palliative care in the community
Daniel Munday and Jeremy Dale
BMJ 2007 334: 809-810. [Extract] [Full Text] [PDF]

Advance care planning in primary care
Scott A Murray, Aziz Sheikh, and Keri Thomas
BMJ 2006 333: 868-869. [Extract] [Full Text] [PDF]

Factors influencing death at home in terminally ill patients with cancer: systematic review
Barbara Gomes and Irene J Higginson
BMJ 2006 332: 515-521. [Abstract] [Full Text] [PDF]

Developing primary palliative care
Scott A Murray, Kirsty Boyd, Aziz Sheikh, Keri Thomas, and Irene J Higginson
BMJ 2004 329: 1056-1057. [Extract] [Full Text] [PDF]

A systematic review of physicians' survival predictions in terminally ill cancer patients
Paul Glare, Kiran Virik, Mark Jones, Malcolm Hudson, Steffen Eychmuller, John Simes, and Nicholas Christakis
BMJ 2003 327: 195. [Abstract] [Full Text] [PDF]

Qualitative research in health care: Analysing qualitative data
Catherine Pope, Sue Ziebland, and Nicholas Mays
BMJ 2000 320: 114-116. [Extract] [Full Text] [PDF]

Qualitative research in health care: Assessing quality in qualitative research
Nicholas Mays and Catherine Pope
BMJ 2000 320: 50-52. [Extract] [Full Text] [PDF]

ABC of palliative care: Communication with patients, families, and other professionals
Ann Faulkner
BMJ 1998 316: 130-132. [Extract] [Full Text] [PDF]

Terminal cancer care and patients' preference for place of death: a prospective study.
J Townsend, A O Frank, D Fermont, S Dyer, O Karran, A Walgrove, and M Piper
BMJ 1990 301: 415-417. [Abstract] [PDF]

Related external webpages:

Daniel Munday talks to Duncan Jarvies in the BMJ podcast

This article has been cited by other articles:

  • Workman, S. (2009). Death rarely desired, anywhere. BMJ 339: b3265-b3265 [Full text]  

Rapid Responses:

Read all Rapid Responses

Place of death up to both the patient and the physician
Alvaro J Ruiz MD, MSc, FACP
bmj.com, 21 Jul 2009 [Full text]
Death rarely desired, in any location
Stephen Workman
bmj.com, 24 Jul 2009 [Full text]
The need to be openess with patients about the discussion of the place of death
David J Oliver
bmj.com, 5 Aug 2009 [Full text]
Advance Care Planning can be of benefit to patients, but there are concerns
Eleanor Grogan
bmj.com, 6 Aug 2009 [Full text]
In your home or in a hotel?
Fernando Verdú, et al.
bmj.com, 18 Aug 2009 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ